YAKIMA COUNTY DISTRICT COURT In the Matter of the Change of Name of: ___________________________________, [Print legibly or type your full name here] NO.: ORDER CHANGING NAME [ADULT] Petitioner I. BASIS 1.1 A verified Petition was filed with the Court requesting that the name of: First: be changed to First: Middle: Last: Middle: Last: 1.2 A hearing was held on the date written below. 1.3 Petitioner is is not subject to the jurisdiction of the Washington Sate Department of Corrections. 1.4 Petitioner is is not subject to the sex offender registration laws of the State of Washington. II. FINDINGS Based on the case record to date and the testimony at the hearing, the Court finds: 2.1 The statements in the Petition are true. ORDER NAME CHANGE ­ ADULT 5/2004 Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com 2.2 Petitioner is subject to the sex offender registration laws of the State of Washington. The Court finds the name change would not interfere with legitimate law enforcement interests, or that the Petition was made for religious or legitimate cultural reasons or in recognition of marriage or dissolution of marriage. Petitioner is subject to the jurisdiction of the Washington State Department of Corrections. The Court finds the name change would not interfere with legitimate penoligical interest, or that the Petition was made for religious or legitimate cultural reasons or in recognition of marriage or dissolution of marriage. 2.3 The Petition for Change of Name is not made for any illegal or fraudulent purpose. 2.4 The Petition for Change of Name will not be detrimental to the interest of any other person. 2.5 The Petition should be granted. III. ORDER It is ORDERED: 3.1 The name of First: is changed to First: for all purposes. 3.2 Petitioner shall provide a copy of this Order within five days to the Washington State Department of Corrections if (s)he is subject to the jurisdiction of that Department. Petitioner shall provide a copy of this order within five days to the Yakima County Sheriff's Office and the Washington State Patrol if (s)he is subject to the sex offender registration laws of this state. FAILURE TO ABIDE BY THIS SECTION IS A CRIME PUNISHABLE BY JAIL AND FINES. Middle: Last: Middle: Last: Date JUDGE/COURT COMMISSIONER I do hereby certify that the foregoing instrument is a true and correct copy of the original now on file in Yakima District Court, in Witness Whereof, I hereby set my hand this _______ day of ___________________, 20______ By: ______________________________________________ Deputy Clerk ORDER NAME CHANGE ­ ADULT 5/2004 Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com