(Copy Receipt) (Clerks Date Stamp) SUPERIOR COURT OF WASHINGTON COUNTY OF SPOKANE In re the Petition for Change of Name of: CASE NO. ____________________________ ORDER APPOINTING GUARDIAN AD LITEM ___________________________________ FOR PETITION FOR CHANGE OF NAME OF a Minor Child A MINOR CHILD A motion for order appointing a guardian ad litem has been filed. It appears that good cause exists to appoint a guardian ad litem for certain limited purposes, therefore, IT IS ORDERED: 1. APPOINTMENT OF GUARDIAN AD LITEM. That ____________________________________ is appointed guardian ad litem for the minor child(ren), _______________________________________________, for the limited purposes of reporting and recommending to the Court as to the best interest of the child(ren) concerning the petition for change of name. 2. TERMINATION OF APPOINTMENT. This appointment shall terminate upon entry an Order for Change of Nam of e of a Minor Child(ren). Other: _______________________________________________________________ _____________________________________________________________________ ORD APPOINT GAL FOR PETITION CHANGE OF NAME OF MINOR CHILD PAGE 1 OF 2 (Rev: 10/2001) >>>> 2 3. OTHER PROVISIONS. Does not apply. Costs shall be advanced for the guardian ad litem as follows: __________________________________________________________________ __________________________________________________________________ The undersigned guardian ad litem agrees to this appointment, understands the nature of this action and accepts the following responsibility to investigate and report to the Court as to the best interest of the child(ren concerning the change of name petition. 4. OTHER. _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ Dated: JUDGE/COURT COMMISSIONER Presented by: Signature ___________________________________________ Print or Type Name Approved as to form, notice of presentation waived: Approved: Guardian Ad Litem Non-Petitioning Party ORD APPOINT GAL FOR PETITION CHANGE OF NAME OF MINOR CHILD PAGE 2 OF 2 (Rev: 10/2001)