____________________________ (Name) _____________________________ (Address) _____________________________ (City) _____________________________ (Telephone) ____________ DISTRICT COURT, ______________________ COUNTY, UTAH COURT’S ADDRESS: _____________________________________________________ IN THE MATTER OF THE NAME CHANGE OF: ______________________________,. PROOF OF SERVICE BY MAIL (Petitioner’s Affidavit) (minor’s name) Case No. ____________________ A minor. Judge _______________________ I am the Petitioner in this matter. I certify that I placed a completed and signed Summons, along with the Petition for Minor’s Name Change in this matter, in an envelope addressed to the following person(s): ___________________________________________________________________ (name of person to whom documents were mailed) I caused this envelope to be delivered to respondent by: [ ] United States Mail, requiring that person to sign a document indicating receipt. [ ] Commercial courier service, requiring that person to sign a document for receipt. Minor’s Name Change: Proof of Service by Mail, p. 1 Approved: November 19, 2004 American LegalNet, Inc. www.USCourtForms.com I have attached a copy of the Summons, as well as the original document that was signed to indicate receipt of the envelope containing the Summons and Petition for Minor’s Name Change. DATED: _________________________ ____________________________________ Petitioner NOTARY CLAUSE _________________________________, Petitioner, is personally known to me or presented satisfactory proof of identity to me. After being sworn and while under oath, Petitioner stated that he or she was acting voluntarily, had read and understood the preceding document, and that the contents were true. Petitioner then signed the document in my presence. Signed on _________________, 20____. X_________________________________________ Notary Public/Court clerk (Notary Seal) Minor’s Name Change: Proof of Service by Mail, p. 2 Approved: November 19, 2004 American LegalNet, Inc. www.USCourtForms.com