KING COUNTY DISTRICT COURT STATE OF WASHINGTON In re the Petition of: ________________________________ ) ) for the Change of Name of: ) ) ________________________________ ) A Minor. [First, Middle Last Name] ) No. _________________________ PETITION FOR CHANGE OF NAME OF A MINOR Comes now ________________________________________ (legibly print full name) and First, Middle, Last ________________________________________________(legibly print full name) petitioning First, Middle, Last the court for an order changing the name of _________________________________________ First, Middle, Last (legibly print current name) his, her, their (circle one) son, daughter, ward (circle one), to the name ________________________________________________________ , and states that: First, Middle, Last 1. The child is __ years of age and was born on _____________, at _________________. (date of birth) (place of birth) 2. Is the child a resident of King County, Washington? Yes No 3. Is the child required to register as a sex offender? Yes No [Failure to provide required notice to the King County Sheriff and Washington State Patrol is a crime. RCW 9A.44.130(8).] 4. Is the child an offender under the jurisdiction of the Department of Corrections? Yes No [Failure to provide required notice to the DOC is a crime. RCW 4.24.130.] 5. Is/are the petitioner(s) the parent(s) of the child? Yes No 6. If not the parent(s), is/are the petitioner(s) the child’s legal guardian and have the legal No authority to submit this petition. Yes 7. The child’s other parent: A. Has given consent to this name change and signed the petition. Yes No B. Has not given consent to this name change. Yes No C. Has not been located and has had no contact with petitioner. Yes No Date of last contact with other parent: ____________________________________ Revised 7/2010 1 American LegalNet, Inc. www.FormsWorkFlow.com 8. Has the child ever had a name change prior to this petition? Yes No Please explain. (Date, place, reason) _________________________________________ _______________________________________________________________________ 9. I/we declare this petition is not made for any illegal or fraudulent purpose. 10. I/we declare this petition will not be detrimental to the interests of anyone else. 11. Any child named in this petition who is age 14 or older joins in the petition and has signed the petition. 12. Petitioner(s) request a change of name for the following reason(s). Please explain. ____________________________________________________________________ ____________________________________________________________________ I DECLARE UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING STATEMENTS IN THIS PEITION FOR A NAME CHANGE OF A MINOR ARE TRUE AND CORRECT. Signed at ____________________________, Washington, on ____________________, 20___. City Date ____________________________________ Parent/Guardian Signature ___________________________________ Parent/Guardian Signature ____________________________________ Parent/Guardian Printed Name ____________________________________ Parent/Guardian Printed Name ____________________________________ Minor’s Signature (if over 14 years of age) ____________________________________ Minor’s Printed Name Received: ___________________________ Court Clerk Revised 7/2010 2 American LegalNet, Inc. www.FormsWorkFlow.com