SUPERIOR COURT OF CALIFORNIA COUNTY OF EL DORADO CIVIL DIVISION 3321 Cameron Park Drive Cameron Park, CA 95682 (530) 621-5867 CONFIDENTIAL INFORMATION RE: PETITION FOR NAME CHANGE (ADULTS AGES 18 & Over) TO: EL DORADO COUNTY SHERIFF'S OFFICE RETURN THE CRIMINAL HISTORY INFORMATION DIRECTLY TO THE ABOVE COURT. Pursuant to Code of Civil procedure, §1279.5, the following information is being submitted to the El Dorado County Sheriff's Office for determination through the California Law Enforcement Telecommunications System (CLETS) and the Criminal Justice Information System (CJIS) whether or not the below named applicant is under the jurisdiction of the Department of Corrections, is on probation or parole, or is required to register as a sex offender pursuant to §290 of the Penal Code. El Dorado Superior Court Case No.:________________________________________________ Name of Applicant:______________________________________________________________ AKA' S:_______________________________________________________________________ Address:______________________________________________________________________ ______________________________________________________________________________ Phone Number:_________________________________________________________________ Date & Place of Birth:____________________________________________________________ Social Security Number:__________________________________________________________ The undersigned hereby submits the above information and authorizes the El Dorado County Superior Court to receive any criminal history information obtained. Date:______________ ____________________________________ Petitioner's signature Local Form C-2 11/05 American LegalNet, Inc. www.USCourtForms.com