KING COUNTY DISTRICT COURT South Division, Vashon Branch In the Matter of the Petition of ) ) NO .______________________ ______________________________________ ) ) PETITION FOR CHANGE OF NAME for the Change of Name of, ) (MINOR) ______________________________________ ) A Minor ) ______________________________________________________________________________________________________ COMES NOW ____________________________ petitioning for an order changing the name of ________________________ his/her/their (son) (daughter) (ward) to ____________________________, and states that: 1. 2. 3. 4. 5. 6. The child is _________ years of age and was born on ____________________, at ____________________________. (date of birth) (place of birth) Is the child a resident of King County in the State of Washington? Yes No Is the child a citizen of the United States? Yes No Is the child required to register as a sex offender? (If the child is required to register, you shall submit a copy of this Petition to the King County Sheriff and the Washington State Patrol not fewer than five days before the entry of an order granting the name change under RCW 4.24.130? Yes No Petitioner(s) is/are the (natural) (adoptive) mother/father of the child. (circle response) If Petitioner is the child’s legal guardian, does he/she have the legal authority to submit this Petition? Yes No The other natural/adoptive parent has: [ ] Given consent to this change of name and has signed the Petition and Order changing name. [ ] Not given consent to this change of name. [ ] Not been found and has had no contact with the Petitioner since ____________________________. (date) This Petition is not made to avoid creditors or for any illegal or fraudulent purpose. The change of name will not be detrimental to the interests of any other person. Any child who is subject to this Petition who is age 14 or older has joined in this Petition. Petitioner(s) request(s) to change the child’s name for the following reasons: ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ I certify under penalty of perjury under the laws of the State of Washington that the statements provided in this Petition are true and correct. Dated this ______ day of ___________________, ________ Signed at _________________________________________ (City and State) _________________________________________________ Petitioner’s signature _________________________________________________ Petitioner’s signature _________________________________________________ Child’s signature (if over 14 years of age) _________________________________________________ Court Clerk KCDCF# 64a/01 American LegalNet, Inc. www.FormsWorkflow.com