Fill and Sign the And I Solemnly Swear or Affirm Form

Consent to Minor’s Name Change, p. 1 Approved: November 19, 2004 (Name) (Address) (City) (Telephone) DISTRICT COURT, COUNTY, UTAH COURT’S ADDRESS: IN THE MATTER OF THE NAME CHANGE OF: ,. CONSENT TO MINOR’S NAME CHANGE (minor’s name) A minor. Case No. ____________________ Judge _______________________ My name is , and I solemnly swear or affirm (name of person consenting to minor's name change) that the following facts are true: 1. I have the following relationship to , who was (minor’s current legal name) born on , for whom a name change petition has been filed. I am the minor’s: (minor’s date of birth) natural or adoptive father natural or adoptive mother custodian by court order (attach court order) guardian by court order (attach court order) Consent to Minor’s Name Change, p. 2 Approved: November 19, 2004 other (explain) __________________________________________________ 2. I have read the Petition for Minor’s Name Change, and agree with it. 3. I know that I have a right to discuss the name change petition with an attorney of my choice. 4. I know that I have a right to disagree with and contest the proposed name change, by filing a written response to the name change petition, 5. I know that I have a right to participate in these name change proceedings, either by myself or through an attorney. 6. I understand that, if the court grants the name change, the new legal name of the minor will affect me as follows: The minor will no longer have the same name as I do. The minor will have the same name as I do. Other (explain) : 7. I understand that changing the minor’s legal name does not affect my legal relationship to the minor. I will retain my lawful rights or obligations to the minor which, depending on my situation, may include but not be limited to the following: custody, guardianship, parent time, child support, day care, health care, tax deductions, inheritance, and/or providing for the minor’s daily and ongoing physical, emotional, and moral care and well-being. 8. I agree and consent to changing to (minor’s current legal name) Consent to Minor’s Name Change, p. 3 Approved: November 19, 2004 , and believe this name change is in the (proposed new legal name for minor) minor’s best interest. DATED: ____________________________________ Signature NOTARY CLAUSE , Affiant, is personally known to me or presented satisfactory proof of identity. After being sworn and while under oath, Affiant stated that he or she was acting voluntarily, had read and understood the preceding document, and that the contents were true. Affiant then signed the document in my presence. Signed on , 20    . X_________________________________________ Notary Public/Court clerk (Notary Seal)