(Copy Receipt) (Clerks Date Stamp) SUPERIOR COURT OF WASHINGTON COUNTY OF SPOKANE In re the Petition for Change of name of: CASE NO. _________________________ ________________________________________ PETITION FOR CHANGE OF NAME OF A MINOR CHILD A Minor Child I. BASIS 1.1 IDENTIFICATION OF PETITIONER(S). Name Relationship to Child 1.2 IDENTIFICATION OF NON-PETITIONING PARTY. Name Name Relationship to Child Relationship to Child PETITION FOR CHANGE OF NAME OF A MINOR CHILD PAGE 1 OF 3 (Rev: 10/2001) >>>> 21.3 CHILD(REN) WHOSE NAME IS TO BE CHANGED. FROM: TO: Name Age _______________________________ _____________________________ FROM: TO: Name ______________________________________________________________________________________________ _ Age _______________________________ _____________________________ 1.4 This petition is not made to avoid creditors or for any illegal or fraudulent purpose. 1.5 The minor child(ren) described above is/are not required to register as a sex offender pursuant to RCW 9A.44.130 The following child(ren) is/are required to register as a sex offender pursuant to RCW 9A.13.00: 1.6 BEST INTEREST OF THE CHILD(REN). The requests made in this petition are in the best interests of the child(ren) for reasons below: 1.7 PARENTS. The parents of the child(ren) are married. The parents of the child(ren) are divorced. Date of and Court granting order are:_______________________________________. The parents have not been married No order of paternity has been entered. A order of paternity has been entered. Date of and Court granting order are:. __________________________________ mother father is deceased 1.8 OTHER: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ PETITION FOR CHANGE OF NAME OF A MINOR CHILD PAGE 2 OF 3 (Rev: 10/2001) >>>> 3 II. RELIEF REQUESTED The petitioner REQUESTS that the Court enter an order changing the name(s) of the child(ren) as described above. Dated: ______________________________ Signature of Lawyer or Petitioner _______________________________________ Print or Type Name I declare under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. Signed at _______________________ [City and State], on ________________________ [Date]. Signature _______________________________________ Print or Type Name JOINDER The non-petitioning party__________________________________ joins in th e petition and consents to the request for change of name. By joining in the petition, he/she agrees to the entry of an order granting the petition without further notice. Dated:__________________________ Signature of Non-Petitioning Party _______________________________________ Print or Type Name CONSENT The minor child _____________________________ being fourteen years of age or older, voluntarily consents to the change of name requested in the petition as set forth above. Dated: __________________________ Signature of Minor Child _______________________________________ Print or Type Name PETITION FOR CHANGE OF NAME OF A MINOR CHILD PAGE 3 OF 3 (Rev: 10/2001)