SUPERIOR COURT OF THE STATE OF CALIFORNIA, COUNTY OF PLACER Form Adopted for Mandatory Use www.placer.courts.ca.gov Superior Court of California, County of Placer Form No. PL-CV003 Effective 10-26-2018 Case Number: Clets Background Information Supplement (Addendum to Name Change Packet) This form will be kept confidential by the Clerk Full Name: Also Known As: Social Security Number: Driver's License Number: Date of Birth: Sex (as stated on Original Birth Certificate): Male or Female Current Residence Address (Street, City, Country, and Zip Code): American LegalNet, Inc. www.FormsWorkFlow.com