KITSAP COUNTY DISTRICT COURT, STATE OF WASHINGTON In the Matter of the Change of Name of: NO. __________________________________________, Minor Child, PETITION FOR CHANGE OF NAME (MINOR) __________________________________________, By Guardian (Petitioner). THIS MATTER shall be heard on ____________________, 20_______, at 9:00 am, at: 614 Division Street, Room ________ Port Orchard, WA COMES NOW ________________________ as guardian of minor child ________________________ and petitions the above-entitled court for an order changing minor child’s name to ________________________ and shows the court as follows: 1. Minor child 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. Minor child has been known as ______________________________ for a period of __________ and requests this court to change his/her name to ______________________________ for the reason that: 3. This petition is in the best interest of the minor child and not made for any illegal or fraudulent purpose, but for the bona fide purpose of changing the minor child’s name to the name by which he/she has been and prefers his/her name to be referred. WHEREFORE, petitioner prays that minor child’s 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