Petition for Minor's Name Change p. 1 Approved November 19, 2004 Revised May 14, 2019 Name Address City, State, Zip Phone Check your email. You will receive information and documents at this email address. Email I am [ ] Petitioner In the District Court of Utah Judicial D istrict County Court Address In the matter of the name change of (Minor's name) A minor. Petition for Minor's Name Change (Utah Code 42 - 1 - 1) Case Number Judge 1. I am asking this Court to change the name of a minor. (A minor is a person who is less than 18 years old.) 2. First name Middle n ame (if any) Surname 3. My relationship to the minor is: [ ] mother (by birth or through adoption) [ ] father (by birth or through adoption) American LegalNet, Inc. www.FormsWorkFlow.com Petition for Minor's Name Change p. 2 Approved November 19, 2004 Revised May 14, 2019 [ ] other (such as custodian or guardian; court order must be attached): 4. The following information describes the minor: Name on birth certificate: Date of birth: Place of birth: : * Date when minor began living in county where petition is filed : ** Name of adult who lives with minor, has physical custody, and provides care : * Minor must live in county where petition is filed ** Minor must live in this county for at least one year before the petition is filed. 5. court orders appointing the guardian or custodian. Here is what I know about those orders: Date signed by judge Case number Court name Copy attached? 6. (check the box for the correct paragraph below, and draw a line through the incorrect paragraph): [ ] al signed consent is attached, or it will be filed before the hearing on this petition. [ ] has not signed a written consent to the proposed name change. The father will be served a copy of this petition, along with a summons requesting a American LegalNet, Inc. www.FormsWorkFlow.com Petition for Minor's Name Change p. 3 Approved November 19, 2004 Revised May 14, 2019 written response within 21 days if served in Utah (or within 30 days if served outside of Utah). 7. (check the box for the correct paragraph below, and draw a line through the incorrect paragraph): [ ] consent is attached, or it will be filed before the hearing on this petition. [ ] has not signed a written consent to the proposed name change. The mother will be served with a copy of this petition, along with a summons requesting a written response within 21 days if served in Utah (or within 30 days if served outside of Utah). 8. The new name will benefit the minor. Here are the reasons why: (In the lines below, describe any of the following facts that apply, or others: (a) (b) how long the minor has used the present name or proposed name; (c) difficulties embarrassment, or harassment caused by the present name; and (d) whether the present name causes insecurity and lack of identity.) [Check a box below for the correct paragraph 9. Cross out the incorrect paragraph 9, to show it does not apply.] 9. [ ] The minor is old enough to make intelligent and decisive choices, and wants to make this name change because: [ ] The minor is not old enough to make an intelligent and decisive choice about this name change. 10. 11. ged. 12. Except for this petition, the minor is not presently involved in any legal proceeding. American LegalNet, Inc. www.FormsWorkFlow.com Petition for Minor's Name Change p. 4 Approved November 19, 2004 Revised May 14, 2019 13. The minor is not on probation or parole. 14. The minor is not on the Child Abuse Offender Registry. (Utah Code 77-43-105(7)) 15. The minor is (Choose one.): [ ] not on the Sex and Kidnap Offender Registry. [ ] is on the Sex and Kidnap Offender Registry. Changing their name is not against the public interest because (Explain.): 16. I am filing a Certification Regarding Offender Registry completed by the Utah Department of Corrections. 17. anyone with a claim against the minor or me. 18. This name change will not affect any right, title, or interest of anyone else, except for the parent, custodian, or guardian named above. Any parent, custodian, or guardian who has not provided a written consent to this name change will be served with this petition pursuant to Rule 4 of the Utah Rules of Civil Procedure, and have an opportunity to participate in these name change proceedings. 19. If it is not possible to serve the other parent, then I will prepare and file the pleadings necessary to ask the Court to waive service [Note to petitioner: Those pleadings are described in the instructions, and are called (1) Motion to Waiver Service.] I declare under criminal penalty under the law of Utah that everything stated in this document is tr ue. Signed at (city, and state or country). Date Printed Name American LegalNet, Inc. www.FormsWorkFlow.com