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 MINOR CHILD [351] A Minor HONORABLE: STATEMENTS TO THE COURT, UNDER OATH 1. INFORMATION ABOUT ME, THE APPLICANT: Name: Address: Date of Birth: Place of Birth: County of Residence: INFORMATION ABOUT THE MINOR CHILD FOR WHOM THIS NAME CHANGE IS REQUESTED: Name: Address: Date of Birth: Place of Birth: County of Residence: Relationship to Applicant: Requested Name: REASON FOR THIS REQUEST FOR CHANGE OF NAME I request that the current name of be changed to 2. 3. , for the following reason(s): Page 1 of 2 CV_ANCM_COSCPinal_04.09.12 Use only most current version American LegalNet, Inc. www.FormsWorkFlow.com 4. ADDITIONAL STATEMENTS A. This application is made solely for the best interest of the minor child named above. It will not release the person from any obligations incurred or harm any rights of property or action in any original name. OATH AND VERIFICATION OF APPLICANT: STATE OF ARIZONA COUNTY OF PINAL ) ) 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 2 of 2 CV_ANCM_COSCPinal_04.09.12 Use only most current version American LegalNet, Inc. www.FormsWorkFlow.com