Full Name of Party Filing Document Mailing Address (Street or Post Office Box) City, State and Zip Code Telephone Email Address (if any) IN THE DISTRICT COURT FOR THE JUDICIAL DISTRICT FOR THE STATE OF IDAHO, IN AND FOR THE COUNTY OF IN RE: Legal name of child Case No. PETITION FOR NAME CHANGE (Minor) Fee Category: Filing Fee: I certify: 1. I am the parent legal guardian of the above child. My full legal name and current residence are listed above. 2. The child was born on (date) county of resides at . 3. a. The child's father is living. or The child's father is not living and the names and addresses of his closest blood relatives are: . b. The child's mother is living. or The child's mother is not living and the names and addresses of her closest blood relatives are: . PETITION FOR NAME CHANGE (Minor) CAO NCM 1-1 07/01/2016 American LegalNet, Inc. www.FormsWorkFlow.com , , state of , in the city of , and , PAGE 1 4. I want to change the child's name to because . 5. The name change is not to avoid creditors or outstanding debts. The child is not required to register as a convicted sexual offender under Chapter 83, Title 18, Idaho Code, or under the provisions of similar laws enacted by another state. I ask that a Deputy Clerk of the Court issue a Notice of Hearing to be published for four (4) successive weeks in the , a newspaper printed in this County; and the Judge sign an Order changing the child's name as I have asked. CERTIFICATION UNDER PENALTY OF PERJURY I certify under penalty of perjury pursuant to the law of the State of Idaho that the foregoing is true and correct. Date: Typed/printed name Signature PETITION FOR NAME CHANGE (Minor) CAO NCM 1-1 07/01/2016 PAGE 2 American LegalNet, Inc. www.FormsWorkFlow.com