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Petition For Legal Change Of Name Form. This is a Nevada form and can be use in Washoe County.
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Tags: Petition For Legal Change Of Name, 3490, Nevada County, Washoe
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Code $3490
Name_____________________________
Address___________________________
____________________________
Telephone Number___________________
Acting In Proper Person
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IN THE FAMILY DIVISION
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OF THE SECOND JUDICIAL DISTRICT COURT OF THE STATE OF NEVADA
IN AND FOR THE COUNTY OF WASHOE
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In the Matter of the Petition Of:
________________________________,
(Your present name)
Case No._____________________
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Dept. No._____________________
For a change of name.
________________________________/
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PETITION FOR LEGAL CHANGE OF NAME
____________________________________________________, acting in proper person,
(Your present name)
petitions this Court as follows:
I.
Petitioner,__________________________________, was born in __________________,
(Your present name)
(City)
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______________________, on _________________________to _________________________
(State)
(Date of birth)
(Father’s name)
__________________ and _________________________________, who __________________
(Mother’s name)
(Were or were not)
husband and wife.
II.
I wish to change my name from______________________________________________
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to__________________________________________________ because:
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_____________________________________________________________________________
(State reason for wanting name change)
_____________________________________________________________________________
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_____________________________________________________________________________
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_____________________________________________________________________________
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_____________________________________________________________________________
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_____________________________________________________________________________
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_____________________________________________________________________________
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_____________________________________________________________________________
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_____________________________________________________________________________
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_____________________________________________________________________________
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_____________________________________________________________________________
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III.
I have _______________ been convicted of a felony.
(Have or have not)
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If I have been convicted of a felony, each offense, the date of conviction, the County and
State of conviction, and the final result are as follows:
_____________________________________________________________________________
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_____________________________________________________________________________
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_____________________________________________________________________________
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_____________________________________________________________________________
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_____________________________________________________________________________
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_____________________________________________________________________________
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_____________________________________________________________________________
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I am not seeking a name change for any illegal purpose. My correct Social Security
number appears on the Court Information Sheet in the confidential envelope in the file.
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IV.
I currently reside at:
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___________________________
(Address)
____________________________
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____________________________
____________________________
(Telephone number)
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and I have lived there since ____________________and have been a resident of Nevada for
(When you moved to present address)
_________________________________. My previous address was:______________________
(Length of time you have lived in Nevada)
(Your previous address)
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______________________________________, and I resided there for ____________________.
(County, State, Zip Code)
(How long you lived there)
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V.
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I am requesting that my name be legally changed to:
____________________________________________________________________________
(Clearly print your full new name as is will appear on all your legal documents)
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VI.
I (do or do not) _____________wish to have a new birth certificate issued showing my new
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name as my original name.
DATE:______________________________
_____________________________
(Print name)
_____________________________
(Signature)
_____________________________
(Address)
_____________________________
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_____________________________
(Telephone number)
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VERIFICATION
STATE OF NEVADA
)
) ss:
County of ________________)
______________________________________, being first duly sworn under penalties of
(Your name)
perjury, deposes and says:
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I am the Petitioner in the above-entitled action; that all the claims and allegations in the
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Petition are true of my own knowledge, except for those matters therein contained stated upon
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information and belief, and as to those matters I believe them to be true.
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_____________________________________
(Signature)
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SUBSCRIBED and SWORN to before me
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this _______ day of __________________, _____
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________________________________________
NOTARY PUBLIC
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ACKNOWLEDGMENT
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STATE OF NEVADA
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County of Washoe
)
)ss:
)
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On this _____day of __________________, ____, personally appeared before me, the
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undersigned, a Notary Public in and for the County of Washoe, State of Nevada,
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______________________________________, personally known to me or proved to me, to be the
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person whose name is subscribed to the attached instrument who acknowledged that (she/he)
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________ executed the attached instrument.
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______________________________
NOTARY PUBLIC
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SECOND JUDICIAL DISTRICT COURT
COUNTY OF WASHOE, STATE OF NEVADA
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AFFIRMATION
Pursuant to NRS 239B.030
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The undersigned does hereby affirm that the preceding document,
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(Title of Document)
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filed in case number:
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Document does not contain the social security number of any person
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-OR-
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Document contains the social security number of a person as required by:
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A specific state or federal law, to wit:
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______________________________________________________
(State specific state or federal law)
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-or-
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For the administration of a public program
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-or-
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For an application for a federal or state grant
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-or-
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Confidential Family Court Information Sheet
(NRS 125.130, NRS 125.230 and NRS 125B.055)
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Date:
(Signature)
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(Print Name)
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(Attorney for)
Affirmation
Revised December 15, 2006
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