Presented by: Petitioner Street Address City, State, Zip King County District Court State of Washington _______________Division ORDER CHANGING NAME In the matter of the Petition of ) ) __________________________________________ ) ) No. _______________________________________ The Petition of the above-named person for an order changing his/her present name, came regularly to be heard this date; the court having heard the evidence and it appearing to the satisfaction of the court that the allegations of the Petition for Change of Name are true; now therefore, it is hereby ORDERED, ADJUDGED AND DECREED that the name of ________________________________________ __________________________be changed to ______________________________________________________. DONE IN OPEN COURT this _______________________day of ___________________________. ______. __________________________________________ JUDGE/COURT COMMISSIONER CERTIFICATION - State of Washington, County of King The undersigned, duly authorized clerk of the King County District Court, Washington, hereby certifies that the document on which this stamp is imprinted is a true and correct copy of the original filed in the Court. Signed this ______ Day of ___________________, ______. __________________________________________ Court Clerk (Order Changing Name) KCDCF #64/98 American LegalNet, Inc. www.FormsWorkflow.com