Fill and Sign the A Minor is a Person Who is Less Than Form

Minor’s Name Change: Petition, p. 1 Approved: November 19, 2004 Revised July 26, 2017 _____________________________ (Name) _____________________________ (Address) _____________________________ (City) _____________________________ (Telephone) _____________________________ (Email) ____________ DISTRICT COURT, ______________________ COUNTY, UTAH COURT’S ADDRESS: _____________________________________________________ IN THE MATTER OF THE NAME CHANGE OF: ______________________________, PETITION FOR MINOR’S NAME CHANGE (minor’s name) A minor. Case No. __________________________ Judge ____________________________ Petitioner states as follows: 1. I am asking this Court to change the name of a minor. (A minor is a person who is less than 18 years old.) 2. I ask the Court to change the minor’s name to: _____________________________________________________________________ (proposed full new name for minor – first, middle and last) 3. My relationship to the minor is: [ ] mother (by birth or through adoption) [ ] father (by birth or through adoption) [ ] other (such as custodian or guardian; court order must be attached): _____________________________________________________________________ Minor’s Name Change: Petition, p. 2 Approved: November 19, 2004 Revised July 26, 2017 _____________________________________________________________________ 4. The following information describes the minor: Name on birth certificate: Date of birth: Place of birth: Minor’s current address (minor must live in county where petition is filed): Date when minor began living in county where petition is filed: (minor must live in this county for at least one year before the petition is filed.) Name of adult who lives with minor, has physical custody, and provides care Father’s name: Father’s current address: Mother’s name: Mother’s current address : 5. If I am not the minor’s legal guardian or custo dian, I have attached a copy of the court orders appointing the guardian or custodian. Here is what I know about those orders: Date signed by judge Case number Court name Copy attached? 6. If I am not the minor’s natural or adoptive father, then t he father (check the box for the correct paragraph below, and draw a line through the incorrect paragraph) : [ ] has agreed with the proposed name change. The father’s original signed consent is attached, or it will be filed before the hearing on this petition. Minor’s Name Change: Petition, p. 3 Approved: November 19, 2004 Revised July 26, 2017 [ ] has not signed a written consent to the proposed name change. The father will be served a copy of this petition, along with a summons requesting a written response within 21 days if served in Utah (or within 30 days if served outside of Utah). 7. If I am not the minor’s natural or adoptive mother, then the mother (check the box for the correct paragraph below, and draw a line through the incorrect paragraph) : : [ ] has agreed with the proposed name change. The mother’s origina l signed consent is attached, or it will be filed before the hearing on this petition. [ ] has not signed a written consent to the proposed name change. The mother will be served with a copy of this petition, along with a summons requesting a written response within 21 days if served in Utah (or within 30 days if served outside of Utah). 8. The new name will benefit the minor. Here are the reasons why: (In the lines below, describe any of the following facts that apply, or others: (a) how a name cha nge will develop and preserve the minor’s relationship with each parent; (b) how long the minor has used the present name or proposed name; (c) difficulties embarrassment, or harassment caused by the present name; and (d) whether the present name causes insecurity and lack of identity.) _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ [Check a box below for the correct paragraph 9. Cross out the incorrect parag raph 9, to show it does not apply.] [ ] 9. The minor is old enough to make intelligent and decisive choices, and wants to make this name change because: ________________________________________________________________________ ________________________________________________________________________ [ ] 9. The minor is not old enough to make an intelligent and decisive choice about this name change. 10. It is in the minor’s best interest to change to the proposed new name. 11. There is no reason why the minor’s name should not be changed. Minor’s Name Change: Petition, p. 4 Approved: November 19, 2004 Revised July 26, 2017 12. Except for this petition, the minor is not presently involved in any legal proceeding. 13. The minor is not on probation or parole. 14. The minor is not barred as a sex offender under Utah Code 77-41-105(9), or as a child abuse offender under Utah Code 77-43-105(7) from changing their name. 15. I am not changing the minor’s name to avoid cr editors, or to escape or defraud anyone with a claim against the minor or me. 16. This name change will not affect any right, title, or interest of anyone else, except for the parent, custodian, or guardian named above. Any parent, custodian, or guardian who has not provided a written consent to this name change will be served with this petition pursuant to Rule 4 of the Utah Rules of Civil Procedure, and have an opportunity to participate in these name change proceedings. 17. If it is not possible to serve the other parent, then I will prepare and file the pleadings necessary to ask the Court to waive service [Note to petitioner: Those pleadings are described in the instructions, and are called (1) Motion to Waive Service (2) Petitioner’s Affidavit in Support of Motion to Waive Service, and (3) Order to Waiver Service.] I have not included any non-public information in this document. Sign here ► Date Typed or Printed Name On this date, I certify that _________________________________ ___________ ______________________ (name) who is known to me or who presented satisfactory identification, in th e form of ___________________________________________________ ___________ (form of identification) , has, while in my presence and while under oath or affirmation, voluntarily signed this document and declared that it is true. Sign here ► Date Typed or printed name (Court Clerk or Notary Public) Notary Seal