Consent to Name Change Approved November 19, 2004 Revised April 9 , 2019 Page 1 of 2 Name Address City, State, Zip Phone Email In the District Court of Utah Judicial District County Court Address In the Matter of the Name Change of: A minor. Consent to Name Change Case Number Judge My name is , and I solemnly swear or affirm that the following facts are true: 1. I have the following relationship to (name of minor), who was born on (date of birth), for whom a name change petition has been filed. I am the minor's: [ ] natural or adoptive father [ ] natural or adoptive mother [ ] custodian by court order (attach court order) [ ] guardian by court order (attach court order) [ ] other (explain): 2. American LegalNet, Inc. www.FormsWorkFlow.com Consent to Name Change Approved November 19, 2004 Revised April 9 , 2019 Page 2 of 2 3. I know that I have the right to discuss the name change petition with an attorney of my choice. 4. I know I have the right to disagree with and contest the proposed name change, by filing a written response to the name change petition. 5. I know I have the right to participate in these name change proceedings, either by myself or through an attorney. 6. I understand that, if the court grants the name change, the new legal name of the minor will affect me as follows: [ ] The minor will no longer have the same name as I do. [ ] The minor will have the same name as I do. [ ] Other (explain): 7. egal name does not affect my legal relationship to the minor. I will retain my lawful rights or obligations to the minor which, depending on my situation, may include but not be limited to the following: custody, guardianship, parent time, child support, day care, health care, tax physical, emotional, and moral care and well-being. 8. I agree and consent to changing the minor's current name from: First Middle Last to this new legal name: First Middle Last I declare under criminal penalty under the law of Utah that everything stated in this document is true . Signed at (city, and state or country). Sign atu Date Printed Name American LegalNet, Inc. www.FormsWorkFlow.com