REV 4/2/19 JCB 1 NA PETITION 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 ( Print your curre nt legal name you wish to change ) (first) ( middle ) ( last ) ( last ) ( middle ) (first) ( When you moved to Washoe County ) ( city ) ( state ) Code: 3490 Name: Address: Telephone: Email: Self-Represented Litigant IN THE SECOND JUDICIAL DISTRICT COURT OF THE STATE OF NEVADA IN AND FOR THE COUNTY OF WASHOE In the Matter of the Petition of: Case No. , Dept. No. For a Change of Name. / PETITION FOR ADULT NAME CHANGE I petition this Court as follows: 1. I was born on // in , . 2. I am a resident of Washoe County, Nevada. I have been a resident since . 3. I wish to change my name from: to: 4. I wish to change my name because ( Check all that apply): I want to change my name to conform to my gender identity and am exempt from the publication requirement. Other: American LegalNet, Inc. www.FormsWorkFlow.com REV 4/2/19 JCB 2 NA PETITION 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 If more room is needed, attach additional sheets. 5. I HAVE 226OR226 HAVE NOT been convicted of a felony. I DO 226OR226 DO NOT have a criminal record. The details of my conviction(s) or criminal record are: If more room is needed, attach additional sheets. If I have a criminal record, a complete set of original fingerprints taken in the manner described by the Department of Public Safety have been lodged in the Filing Office. 6. I am not seeking a name change for any illegal or fraudulent purpose. This document does not contain the personal information of any person as defined by NRS 603A.040. I declare under penalty of perjury under the law of the State of Nevada that the foregoing is true and correct. Date: Signature: Print Your Name: For each list: 1) the offense, 2) the date, 3) the County and State, and 4) the final result. American LegalNet, Inc. www.FormsWorkFlow.com REV 4/2/19 JCB 3 NA PETITION 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 VERIFICATION I, (your name) , declare that I am the Petitioner in the above-entitled action; that I have read the foregoing Petition and know the contents thereof; that the pleading is true of my own knowledge, except for those matters therein contained stated upon information and belief, and that to those matters, I believe them to be true. I declare under penalty of perjury under the law of the State of Nevada that the foregoing is true and correct. SIGNATURE American LegalNet, Inc. www.FormsWorkFlow.com