Arizona Supreme Court Page 1 of 2 CVNC13F- 010117 Person Filing: Address (if not protected): City, State, Zip Code: Telephone Numbers: Email Address: Representing [ ] Self or [ ] Attorney for Lawyer222s Bar Number: SUPERIOR COURT OF ARIZONA IN COUNTY In the Matter of: Case Number: CONSENT OF MINOR TO NAME CHANGE A Minor (If minor is 14 or older) REQUIRED INFORMATION FROM MINOR, UNDER OATH OR AFFIRMATION: 1. INFORMATION ABOUT ME: Name on Birth Certificate: First Middle Last Address: Telephone Numbers: Date of Birth (Month/Date/Year): Place of Birth (City, State, Nation): [ ] I am the minor who is the subject of this name change request. [ ] I am at least 14 years of age. 2. I have read the Application for Name Change and consent to changing my LEGAL name to: First Middle Last 3. I waive notice of all further proceedings in this matter. For Clerk222s Use Only American LegalNet, Inc. www.FormsWorkFlow.com Case Number: Arizona Supreme Court Page 2 of 2 CVNC13F- 010117 UNDER OATH OR BY AFFIRMATION I swear or affirm under penalty of perjury that the contents of this document are true and correct to the best of my knowledge and belief. Date Minor222s signature if 14 or over STATE OF COUNTY OF Subscribed and sworn to or affirmed before me this: (date) by . (notary seal) Deputy Clerk or Notary Public American LegalNet, Inc. www.FormsWorkFlow.com