Approved Board of District Court Judges August 13, 2008 Revised May 14, 2019 Page 1 of 4 In the District Court of Utah Judicial District County Court Address In the matter of the name change of (Minor's name) A minor. Orde r Changing Minor's Name Case Number Judge 1. Petitioner and the minor appeared in Court on: (date). 2. The minor was born on: (date). 3. The mino birth name was: First name Middle name (if any) Surname The court finds: 4. (a) All notices required by law have been given. (b) [ ] No objections to the proposed name change were made. (c) [ ] Objections to the proposed name change were made by: (d) Written consent to the proposed name change have been filed for the [ ] father, [ ] mother, [ ] custodian, [ ] guardian (e) [ ] The allegations in the petition are true. (f) [ ] Other findings (if any): American LegalNet, Inc. www.FormsWorkFlow.com Approved Board of District Court Judges August 13, 2008 Revised May 14, 2019 Page 2 of 4 The court concludes: 5. (a) The requirements of Utah Code Section 42-1-1 through 42-1-3 have been met. (b) The minor is not on the Child Abuse Offender Registry and is not barred from changing their name. (Utah Code 77-43-105(7)). (c) The minor: [ ] is not on the Sex and Kidnap Offender Registry. [ ] is on the Sex and Kidnap Offender Registry, but granting the petition is not against the public interest (Utah Code 77-41-105(8)(a)). 6. [ ] The allegations in the petition are sufficient and the petition should be granted. 7. The name change [ ] is [ ] is not in the best interest of the minor. The court orders: 8. The Petition is [ ] granted [ ] denied 9. [ ] The current legal name of First name Middle name (if any) Surname is changed to First name Middle name (if any) Surname This new name may be entered on birth certificate and name from this date forward. American LegalNet, Inc. www.FormsWorkFlow.com Approved Board of District Court Judges August 13, 2008 Revised May 14, 2019 Page 3 of 4 the top of the first page of this document. Sign atu Date Judge American LegalNet, Inc. www.FormsWorkFlow.com Approved Board of District Court Judges August 13, 2008 Revised May 14, 2019 Page 4 of 4 Certificate of Service I certify that I filed with the court and am serving a copy of this Order Changing Minor's on the following people. Service Method Service Addr ess Service Date [ ] Mail [ ] Hand Delivery [ ] E - filed [ ] Email [ ] Left at business (With person in charge or in receptacle for deliveries.) [ ] Left at home (With person of suitable age and discretion residing there.) [ ] Mail [ ] Hand Delivery [ ] E - filed [ ] Email [ ] Left at business (With person in charge or in receptacle for deliveries.) [ ] Left at home (With person of suitable age and discretion residing there.) Sign atu Date Printed Name American LegalNet, Inc. www.FormsWorkFlow.com