JDF 421 R 3 - 1 8 PETITION FOR CHANGE OF NAME (MINOR CHILD) County Court District Court Denver Juvenile Court County, Colorado Court Address: I n the Matter of the Petition of : Parent (s) /Petitioner (s) : f or : Minor Child: COURT USE ONLY Attorney or Party Without Attorney (Name and Address): Phone Number: E - mail: FAX Number: Atty. Reg. #: Case Number: Division Courtroom P ETITION FOR CHANGE OF NAME (MINOR CHIL D) 1. Information regarding the minor child : Full Name of Minor Child (First, Middle and Last) Mailing Address Date of Birth 2. The minor child is a resident of County, Colorado. 3. I /We wish to chan ge the name of the minor child to . First Name Middle Name Last Nam e My/Our relationship to the child is . 4. The proposed change would be proper and not detrimental to the interests of any other person and in the best interest of the minor child . 5. The reason for the change of name is 6. The child is is not the subject of a child support, allocation of parental responsibilities, or parenting time action. If so, please identify (case number), (type of case) and (name of Court). 7. The minor child (if 14 years of age or older), has not been adjudicated as a juvenile delinquent for an offense that would constitute a felony if committed by an adult in this state or any other s tate or under federal law. The fingerprint - based criminal history record check for the minor child is attached as Exhibit A and is conducted within 90 days prior to the filing of this Petition . 8. The required notice to the non - custodial parent has been acc omplished by: notice (JDF 422 ) consent (JDF 423) or request to publish (JDF 424) and is filed with this petition Not Applicable (There is no non - custodial parent) I /We , swear/affirm under oath that I have read the foregoing Petition and that the statements contained in this Petition are true to the best of my knowledge and belief. American LegalNet, Inc. www.FormsWorkFlow.com JDF 421 R 3 - 1 8 PETITION FOR CHANGE OF NAME (MINOR CHILD) By checking this box, I am acknowledging I am filling in the blanks and not changing anything else on the form. By checking this box, I am acknowledging that I have made a change to the original content of this form. VERIFICATION AND ACKNOWLEDGEMENT I swear/affirm under oath that I have read the foregoing Petition and that the statements set forth therein are true and correct to the b est of my knowledge. (Printed name of Petitioner ) Signature of Petitioner City State Zip Code (Area Code) Home Telephone Number Area Code) Work Telephone Number Signed and sworn to before me by in the County of , State of , this , day of , 20 . My Commission Expires: Deputy Clerk/Notary Public I swear/affirm under oath that I have read the foregoing Petition and that the statements set forth therein are true and correct to the best of my knowledge. ( P rinted na me of Co - Petitioner) Signature of Co - Petitioner Co - City State Zip Code (Area Code) Home Telephone Number Are a Code) Work Telephone Number Signed and sworn to before me by in the County of , State of , this , day of , 20 . My Commission Expires: Deputy Clerk/Notary Public American LegalNet, Inc. www.FormsWorkFlow.com