$93 payable to Clallam County District II Court & $72 payable to Clallam County Auditor IN THE DISTRICT II COURT OF THE STATE OF WASHINGTON FOR CLALLAM COUNTY In re the Matter of: ) ) ) ) ) ) No. PETITION FOR CHANGE OF NAME D.O.B.-Petitioner 1. I am applying for a court order which will change my name from _____________________________________________________ (Print or type your current full name here) to ________________________________________________________ (Print or type your new full name here exactly as it is to be spelled) 2. 3. 4. My residence is located in Clallam County District Court II judicial district. My date of birth is _______________. My place of birth is _____________________ state. This application is made for the following reasons: ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ 5. This application is not made for any illegal or fraudulent purpose. I am not an offender under the jurisdiction of the Department of Corrections nor am I a sex offender subject to registration under RCW 9A.44.130. The change of name will not be detrimental to the interests of any other person. 6. I declare under penalty or perjury under the laws of the State of Washington that the foregoing statements in this petition are true and correct. Signed at Clallam County, Washington on _______________________20______. ____________________________________ Signature Hearing date: ____________________________________________at 10:00a.m. NameChangePetition admin/forms 05/15/2014 American LegalNet, Inc. www.FormsWorkFlow.com