KITSAP COUNTY DISTRICT COURT, STATE OF WASHINGTON In the Matter of the Change of Name of: NO. __________________________________________, Petitioner. PETITION FOR CHANGE OF NAME (ADULT) THIS MATTER shall be heard on ____________________, 20_______, at 9:00 am, at: 614 Division Street, Room ________ Port Orchard, WA COMES NOW ______________________________ and petitions the above-entitled court for an order changing his/her name to ______________________________ and shows the court as follows: 1. Petitioner was born on the __________ day of _________________________ __________, in ____________________ County, State of ____________________; is a resident of Kitsap County, Washington; and is a citizen/legal resident of the United States of America. 2. Petitioner has been known as ______________________________ for a period of __________ and requests this court to change his/her name to ______________________________ for the reason that: 3. A. B. C. This petition is not made to avoid creditors or for an illegal or fraudulent purpose, but for the bona fide purpose of changing the petitioner’s name to the name by which he/she has been and prefers his/her name to be referred. I am not under the jurisdiction of the department of corrections or (check if appropriate) I have complied with the notification requirements in RCW 4.24.130(2). I am not required under RCW 9A.44.130 to register as a sex offender or (check if appropriate) I have complied with the notification requirements in RCW 9A.44.130(8). WHEREFORE, petitioner prays that his/her name be changed by order of this court from: _________________________________________ to _________________________________________ and that the latter be in place of the former. __________________________________________ Petitioner I certify (or declare) under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. Date Place Petitioner Revised 10/06/10 American LegalNet, Inc. www.FormsWorkFlow.com