Petition For Adult Name Change
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Petition For Adult Name Change Form. This is a Washington form and can be use in Thurston Local County.
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Tags: Petition For Adult Name Change, Washington Local County, Thurston
DI STRI CT CO
URT FO THURSTO CO
R
N UNTY, W
ASHI NG N
TO
I N THE M
ATTER of t he Change of Nam of
e
)
No. ______________________
)
)
PETI TI O FO ADULT NAM CHANG
N R
E
E
Petitioner is a resident of Thurston County, Washington. Petitioner does not seek this name change to defraud or
mislead any person. Petitioner declares further: (check all boxes that pertain to you)
I wish to change my name from: ________________________________________________________
to: __________________________________________________________
Petitioner is currently under the jurisdiction of the Department of Corrections (DOC) and will submit a copy of
the Petition for Name Change to DOC at least five (5) days prior to this hearing.
Petitioner is subject to registration requirements as a sex offender and will submit a copy of this application to
the sheriff of petitioner’s county of residence and to the Washington State Patrol at least five (5) days prior to
this hearing.
A
photo ID is presented with this Petition.
This application is made for the following reasons:
I declare under penalty of perjury under the laws of the State of Washington that the foregoing statements in this petition are
true and correct and that I have checked all boxes that pertain to me.
Signed at
, on
(City and State)
(Date)
_____________________________________________
(Print Petitioner’s Name)
A hearing on this Petition will be held on
(Signature)
at
[ ] am [ ] pm
Check calendars in the lobby for location of courtroom.
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03/05
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