IN THE DISTRICT COURT OF THE STATE OF WASHINGTON IN AND FOR THE COUNTY OF JEFFERSON In re the Matter of: No. PETITION FOR CHANGE OF NAME ____________________________ Petitioner 1. [ ] I request that the court enter an order changing my name from _______________________________to ______________________________________ (Full name) (New Name Desired) 2. [ ] I request that the court change the name of my child or ward from _______________________________to _____________________________________ (Full name) (New Name Desired) 3. I reside in this judicial district 4. This request is made for the following reasons: 5. The request to change names is not made for any illegal or fraudulent purpose. 6. The change of name will not be detrimental to the interests of any other person. 7. I have never been required to register as a sex offender. I declare under penalty of perjury under the laws of the State of Washington that the foregoing statements in this petition are true and correct. Signed at _________________________________________________on ___________________ (City and State) (Date) ________________________________ Petitioner Signature ___________________________ Parent or Guardian Signature ________________________________ Minor child over 14 Signature American LegalNet, Inc. www.FormsWorkflow.com Jefferson County District Court Name Change Procedures An applicant who applies to the court for a change of name, pursuant to RCW 4.24.130 must complete or meet the following requirements: Person whose name is to be changed must reside in this Judicial District • The petition and information must be filed at Jefferson County District Court 1820 Jefferson Street, Port Townsend WA 98368 a hearing will be set approximately 3-4 weeks from time of filing. Hearings: Name Change Hearings are held every Monday at 2:00pm and will be scheduled after the submission of the required information has been received and approved. What to File: If the person whose name is to be changed is 18 YEARS OF AGE OR MORE: 1. 2. 3. 4. Photo identification of the petitioner Copy of the birth certificate of the petitioner Completed petition (can be obtained at District Court) Pay the following fees: District Court filing fee of $53.00 (checks payable to JCDC) Auditors Filing fee of $43.00 (this must be a separate check from District Ct; the court will record your name with Jefferson County Auditor). Certified Copies are $6.00 a piece (inform the clerk of how many copies you want, this can be included in the same check as the District Court filing fee). 5. A copy of your criminal history (DCH). (If you are a resident of Washington the court can provide one for you). If the person whose name is to be changed is UNDER 18 YEARS OF AGE: 1. Photo identification of the petitioner 2. Photo identification of the minor child (if available) 3. Copy of the minor child’s birth certificate 4. Completed petition signed by both parents or a. The original written consents (notarized) of each natural parent or b. A written declaration by the petitioner, under penalty of perjury, as to why the consent of the natural parent(s) should not be required and the original summons and notice of hearing to the non-consenting parent(s). 5. A copy of the court order that places custody of the minor with petitioner (if applicable). 6. Pay the filing fees as listed above 7. A copy of the criminal history (DCH) of the parent requesting the name change 8. The written consent of the minor whose name is to be changed if over the age of 14 American LegalNet, Inc. www.FormsWorkflow.com   The clerk is required by law to ask you if you are under the supervision of the Washington State Department of Corrections (DOC). If you have been convicted of a felony crime, and are under the supervision of the state Department of Corrections, the Court will not grant the petition to change your name unless you prove that you have mailed a copy of the petition to the DOC at least fifteen (15) days before the hearing, and the Courts that changing your name will not interfere with legitimate penological interests. (RCW 4.24.130(2)) The person who received an order changing the name of a person is under the Department of Corrections must submit a copy of the order to DOC within five (5) working days of the entry of the order. The clerk is required by law to ask you if the person whose name is being changed is required to register as a sex offender. If the person whose name is being changed is required to register as a sex offender with state and local law enforcement, the Court will not grant the petition to change the person’s name unless it is proven that a copy of the petition have been served on both the Jefferson County Sheriff’s Office and the Washington State Patrol at least fifteen (15) days prior to the date set for the hearing, and that the changing of the name does not interfere with legitimate law enforcement interests. The person who received an order changing the name of a person required to register as a sex offender must submit a copy of the order to the county sheriff of the county in which they reside and to the Washington State Patrol within five (5) working days of the entry of the order. You are required to notify the following agencies of a name change; If the person whose name has been changed was born in the State of Washington, the Department of Vital Records requires notice of the order changing the person’s name. You must mail a certified copy to: Washington Department of Vital Records, PO Box 9709 ET-14 Olympia, WA 985049709 ** If you are merely reverting to a maiden name after a divorce, you do not need to notify the Department of Vital Records. Other organizations you will need to change your name withSocial Security – http://ssa.gov./online/ss-5.html IRShttp://irs.ustreas.gov/forms_pubs/forms.html Post Office- http://www.usps.gov/moversnet/coa.html Utility Companies (phone, electric, gas, cable, etc.) Dept of Motor Vehicleshttp://www.dol.wa.gov Voter RegistrationFinancial Organizations- (banks, credit cards, life insurance, retirement plans, etc.) Medical Organizations- (medical plan, dental, physician, etc.) Membership Organizations- (clubs and associations) Passport- http://travel.state.gov/download_applications.html Legal Documents- (will, health care proxy, living will, trust, power of attorney, contracts, etc) Notary Public? Don’t forget to notify the state or risk losing your commission. Don’t forget to order checks in your new name American LegalNet, Inc. www.FormsWorkflow.com