(Copy Receipt) (Clerks Date Stamp) SUPERIOR COURT OF WASHINGTON COUNTY OF SPOKANE In re the Petition for Change of Name of: CASE NO. _______________________ _________________________________ MOTION AND DECLARATION FOR ORDER APPOINTING GUARDIAN AD A Minor Child LITEM FOR PETITION FOR CHANGE OF NAME OF MINOR CHILD I. MOTION ___________________________________ [Name] moves the Court for an order providing: 1.1 For appointment of a guardian ad litem for the mnor child(ren) _________________________ i for the limited purpose of investigating, reporting, and recommending to the court as to the best interest of the child concerning the petition for change of name. 1.2 That this appointment terminate upon entryan order determ of ining the petition for change of name or upon further order of the court. 1.3 Other: _______________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ NAMECHANGE-MOT/DEC/ORD APPT GAL MINOR CHILD PAGE 1 OF 2 (Rev: 10/2001) >>>> 2 This motion is based upon the case record to date and the following declaration. Dated: _____________________________ Signature of Lawyer or Moving Party _______________________________________ Print or Type Name II. DECLARATION _________________________________ [Name] declares as follows: 2.1 Declarant is the mother father legal guardian or custodian. 2.2 [ ] It appears that there will be a conflict among the parties as to whether granting the petition for change of name will be in the best interest of the minor child(ren). [ ] Other: ____________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ I declare under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. City and Signed at ___________________________________ [City and ________________________________ Signature _______________________________________ Print or Type Name NAMECHANGE-MOT/DEC/ORD APPT GAL MINOR CHILD PAGE 2 OF 2 (Rev: 06/2001)