IN THE DISTRICT COURT OF COUNTY, NEBRASKA (county where Petition filed) IN RE NAME CHANGE OF CASE No. (case number assigned by lerk of ourt) . (your full name) I, , without the assistance of an attorney, (your full name) ask this ourt for a name change. In support of my Petition, I state that the following items are true: 1.My address is ,(your present street address) , County, Nebraska. (city where you live) (county where you live) 2.I have been a resident of County, Nebraska(county where you live ) for more than one year prior to the filing of this petition. 3.My date of birth is provided on the Confidential Party Information Form (page 3 of the Petition for Name Change). 4.My current name is .(your current full name) 5.I desire the court to change my name of to . (your current full name) (preferred new full name) American LegalNet, Inc. www.FormsWorkFlow.com 6.I desire to change my name for the following reason(s): .WHEREFORE, I respectfully request that the court set this matter for hearing, and that upon such hearing, order my name to be changed from to . (current full name) (preferred full name) Date Your Current Full Name Your Full Street Address/P.O. Box City/State/ZIP Code Phone E-mail Address American LegalNet, Inc. www.FormsWorkFlow.com IN THE DISTRICT COURT OF COUNTY, NEBRASKA (county where Petition filed) THIS DOCUMENT IS CONFIDENTIAL AND SHALL NOT BE MADE PART OF THE COURT FILE OR PROVIDED TO THE PUBLIC PURSUANT TO NEB. CT. R. 6-1521. IN RE NAME CHANGE OF CASE No. (case number assigned by lerk of ourt) . (your full name) Name Gender Birth DatePetitioner: (your current full name) American LegalNet, Inc. www.FormsWorkFlow.com