State of Minnesota County Judicial District: Court File Number: Case Type: District Court Name Change In the Matter of the Application of: First Middle Last On Behalf of (current name of minor(s)): Order Granting Name Change of a Minor (Minn. Stat. § 259.10) First Middle Last For a change of name to (new name of minor(s)): First Middle Last The above entitled matter came on for hearing before the undersigned Judge on _________________________ upon the Application for a Name Change of a Minor(s). Date Upon testimony and files, THE COURT FINDS the following: 1. The application is made in good faith without intent to defraud or mislead. 2. Each minor child who is seeking a name change has lived in the State of Minnesota for at least six months preceding the filing of the application, and now lives at: Street in 3. The applicant is the: minor child (ren). parent City/Town County. legal guardian next of kin (specify): of the State Zip 4. Name of each of minor child and date(s) of birth: 5. The name of the non-applicant parent(s): The non-applicant parent(s) is/are not known and his/her/their name(s) is/are not shown on the birth certificate. American LegalNet, Inc. www.FormsWorkFlow.com NAM208 State ENG Rev 12/06 www.mncourts.gov/forms Page 1 of 2 6. The non-applicant parent(s) has/have received actual notice published notice of the pending of the application for name change of the minor(s). 7. The applicant requests to have the name(s) of each minor child changed to: 8. A. The minor child (ren) has not been convicted of a felony in any state. B. The minor child (ren) has been convicted of a felony as follows: AND Proper notice has been given to the prosecuting authority and Minnesota Attorney General AND No objection has been filed. 9. Legal description of lands in the State of Minnesota upon which the following minor child (ren) has/have claim(s), interest, or lien(s): (Provide the legal description and attach additional pages if necessary.) 10. The change of name is in the best interest of the minor child (ren.) 11. Other: The application is granted and IT IS ORDERED that: The name(s) of the minor(s) shall be All persons having a criminal history who have been granted a name change by this court have a duty to report that name change to the Bureau of Criminal Apprehension within ten (10) days of this order. Other Dated: Judge of District Court DUTY TO REPORT NAME CHANGE Minn. Stat. § 259.11B If you have a criminal history and have changed your name, you have a duty to report your name change to the Bureau of Criminal Apprehension located at 1430 East Maryland Avenue, St Paul, MN 55106, (651)793-2400, within ten (10) days of this order. Failure to do so is a gross misdemeanor punishable by up to one (1) year in prison and/or a fine of $3000. American LegalNet, Inc. www.FormsWorkFlow.com NAM208 State ENG Rev 12/06 www.mncourts.gov/forms Page 2 of 2