Name of Person Filing: Street Address: City, State, Zip Code: Telephone Number: Email Address: ATLAS Number (if applicable) Representing Self (No Attorney) If Attorney, Bar Number: or Represented by Attorney SUPERIOR COURT OF ARIZONA PINAL COUNTY In the Matter of: CASE NUMBER: CV2 APPLICATION FOR CHANGE OF NAME FOR A FAMILY [351] (Names of Persons who request a change of name) HONORABLE: STATEMENTS TO THE COURT, UNDER OATH 1. INFORMATION ABOUT ME, THE APPLICANT Name: Address: Date of Birth: County of Residence: Place of Birth: 2. INFORMATION ABOUT THE PERSON(S) FOR WHOM THIS NAME CHANGE IS REQUESTED Same as listed in Number 1 above. Requested Name: A. Name: Address: Date of Birth: County of Residence: Place of Birth: Relationship to Applicant: Requested Name: Page 1 of 3 CV_ANCF_COSCPinal_04.09.12 Use only most current version American LegalNet, Inc. www.FormsWorkFlow.com B. Name: Address: Date of Birth: County of Residence: Place of Birth: Relationship to Applicant: Requested Name: C. Name: Address: Date of Birth: County of Residence: Place of Birth: Relationship to Applicant: Requested Name: If you wish to include more people in this application, please attach another sheet of paper. List for each person their current name, address, date of birth, county of residence, place of birth, relationship to Applicant, and the new name they request. 3. REASON FOR THIS REQUEST FOR CHANGE OF NAME I request that the names be changed as listed above for the following reasons: 4. STATEMENTS TO THE COURT REQUIRED BY ARIZONA LAW (A.R.S. �12-601(C)) Check the boxes that indicate a true statement. a. I submitted this application solely for the benefit and in the best interest of the persons for whom the name change is requested. I understand and acknowledge that this change of name, if granted, will not release me or anyone for whom a change of name is requested on this application from any obligation incurred or harm any rights of property or action in any previous name. I am not knowingly requesting this change of name to that of another individual for the purpose of committing or furthering any offense of theft, forgery, fraud, perjury, organized crime or terrorism or any other offense involving false statements. Have you or any adult listed above ever been convicted of a felony? If "yes", list all felony convictions on next page. Yes No b. c. d. Page 2 of 3 CV_ANCF_COSCPinal_04.09.12 Use only most current version American LegalNet, Inc. www.FormsWorkFlow.com OATH AND VERIFICATION OF APPLICANT STATE OF ARIZONA PINAL COUNTY ) ) ss. ) I, the Applicant, being duly sworn and under oath, state that I have read this Application. All the statements in the Application are true, correct, and complete to the best of my knowledge and belief. (Applicant's Signature) SUBSCRIBED AND SWORN TO before me this day of 20 By My Commission Expires: (Deputy Clerk/Notary Public) Page 3 of 3 CV_ANCF_COSCPinal_04.09.12 Use only most current version American LegalNet, Inc. www.FormsWorkFlow.com