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) (minor chilcurrent full name(s)) , Minor Child(ren), By Parent or Guardian . (your full name) I, , on behalf of (your full name) current full name(s)) minor child(ren), and without the assistance of an attorney, ask this ourt for a name change for the minor child(ren). In support of this 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.The minor current name(s) is/are current full name(s)) American LegalNet, Inc. www.FormsWorkFlow.com 3.The minor child(ren)address is , (minor child(ren)sent street address) , County, Nebraska. (city where minor child(ren) live(s)) (county where minor child(ren) live(s)) 4.The minor date(s) of birth is/are provided on the Confidential Party Information Form (page 4 of the Petition for Name Change). 5.My relationship to the minor child(ren) is .(mother/father) 6.The minor child(ren) and I have been residents of (county where you and minor child(ren) live) County, Nebraska for more than one year prior to the filing of this Petition. 7.I desire that the court change the name(s) of (minor child(ren)current full name(s)) , minor child(ren), to new full name(s)) . 8.The other parent of the minor child(ren) is . 9.I desire to change the name(s) of the minor child(ren), current full name(s)) American LegalNet, Inc. www.FormsWorkFlow.com for the following reason(s): . I request the court set this matter for hearing, and that upon such hearing, enter an order changing the name(s) of the minor child(ren) from (minor chcurrent full name(s)) to (minor child(ren)preferred new full name(s)) . Date Petitioner Your 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. CASE No. (case number assigned by lerk of ourt) Gender Birth Date IN RE NAME CHANGE OF (minor Name Children: (chi American LegalNet, Inc. www.FormsWorkFlow.com