DISTRICT COURT OF THE STATE OF WASHINGTON FOR WHATCOM COUNTY, Bellingham, Washington In re the Matter of: ) ) ) ) Cause Number ____________________ Petition for Change of Name Petitioner. 1. I am applying for a court order which will change: ) My name from (Current Full Name)__________________________________________________________ First First (Current Full Name) First First Middle Middle Middle Middle Last Last Last Last to (New Name Desired) __________________________________________________________________ The name of my child or ward from __________________________________________________________ to (New Name Desired) ___________________________________________________________________ 2. 3. I reside in this judicial district. This application is made for the following reasons: 4. 5. 6. This application is not made for any illegal or fraudulent purpose. I am not a convicted felon under supervision of the Department of Corrections, nor am I a registered sex offender. (Any such persons must follow different statutory procedures to get a change of name.) The change of name will not be detrimental to the interests of any other person(s). If the name change is for a child under age 18: Both parents agree to the name change. The non-petitioning parent disagrees. The non-petitioning parent has had no contact with the child for approximately __________ years. 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. Signed at__________________________________________________, on ________________________. (City and State) (Date) ______________________________________________________ Signature ______________________________________________________ Address ______________________________________________________ City, State, Zip ______________________________________________________ Phone Number Petition for Change of Name 08/30/2005 American LegalNet, Inc. www.USCourtForms.com