Fill and Sign the Ca Petition Name Form

PETITIONER OR ATTORNEY (Name, State Bar number, and address):                               TELEPHONE NO.:       FAX NO. (Optional) :       E-MAIL ADDRESS (Optional) :       ATTORNEY FOR (Name) :       FOR COURT USE ONLY SUPERIOR COURT OF CALIFORNIA, COUNTY OF       STREET ADDRESS       MAILING ADDRESS       CITY AND ZIP CODE       BRANCH NAME       PETITION OF (Name) :       PETITION FOR CHANGE OF NAME AND GENDER CASE NUMBER: NC-200 Before you complete this petition, you should read the Instructions for Filing a Petition on the next page. You must answer all questions and check all boxes on this petition that apply to you. You must file this petition in the superior court of the county where the person whose name is to be changed resides. 1. Petitioner (present name):       is a resident of this county. Petitioner requests that the court decree that petitioner’s name is changed to (proposed name):       2. Petitioner requests a decree that the petitioner’s gender is changed: (1) from male to female. (2) from female to male. 3. An affidavit or declaration of a physician documenting the gender change through surgical treatment as provided under Health and Safety Code sections 103425 and 103430 is attached to this petition. (Declaration of Physician (form NC-210) may be used for this purpose.) 4. Petitioner requests that the court order that a new birth certificate be issued reflecting the gender and name changes sought by this petition. 5. Petitioner requests that the court issue an order directing all interested persons to appear and show cause why this petition should not be granted. 6. Petitioner provides the following information in support of this petition: a. The information contained in the physician’s affidavit or declaration. b–f. The information contained in the attachment (attach a copy of the attachment Name and Information About the Person Whose Name Is to Be Changed (attachment to Petition) (form NC-110)). (Instructions on next page) Page 1 of 2 Form Adopted for Mandatory Use PETITION FOR CHANGE OF NAME Code of Civil Procedure §, 1275 et seq.; Judicial Council of California AND GENDER Health & Safety Code, §§ 103430, 103435 NC-200 [Rev. July 1, 2006] INSTRUCTIONS FOR FILING A PETITION FOR CHANGE OF NAME AND GENDER 1. Where to File The petition for change of name and gender must be filed in the superior court in the county where the petitioner presently lives. 2. Whose Name May Be Changed The petition may be used to change one’s name and gender. 3. What Forms Are Required You need an original and two copies of each of the following documents: a. Petition for Change of Name and Gender (form NC-200) b. Name and Information About the Person Whose Name Is to Be Changed (Attachment to Petition) (form NC-110) c. Declaration of Physician (form NC-210) (Signed by the physician and attached to form NC-200) d. Order to Show Cause for Change of Name and Gender (form NC-220) e. Decree Changing Name and Gender (form NC-230) 4. Filing and Filing Fee Prepare an original Civil Case Cover Sheet (form CM-010). File the original petition and Civil Case Cover Sheet with the clerk of the court and obtain two filed-endorsed copies of the petition. A filing fee will be charged unless you qualify for a fee waiver. (If you want to apply for a fee waiver, see Application for Waiver of Court Fees and Costs (form 982(a)(17)); Information Sheet on Waiver of Court Fees and Costs (form 982(a)(17)(A)-INFO); and Order on Application for Waiver of Court Fees and Costs (form 982(a)(18).) 5. Requesting a Court Hearing Date You should request a date for the hearing on the Order to Show Cause at least six weeks in the future. 6. Filing the Order to Show Cause After the hearing date has been included and you have obtained a judge’s signature on the Order to Show Cause, file the original order in the clerk’s office and obtain filed-endorsed copies of the order. 7. Publishing the Order to Show Cause A copy of the Order to Show Cause must be published in a local newspaper of general circulation once a week for at least four consecutive weeks before the date of the hearing on the petition. The petitioner selects the newspaper from among those newspapers legally qualified to publish orders and notices. The newspaper used must file a Proof of Publication with the superior court before the hearing. If no newspaper of general circulation is published in the county, the court may order the Order to Show Cause to be posted by the clerk. 8. Domestic Violence Confidentiality Program In cases where the petitioner is a participant in the domestic violence confidentiality program, the petition, the order to show cause published in the newspaper, and the decree should, instead of giving the proposed name, indicate that the name is confidential and on file with the Secretary of State. 9. Court Hearing Bring copies of all documents to the hearing. If the judge grants the name and gender change petition, the judge will sign the original decree. 10. To obtain a new birth certificate reflecting the change of gender, file a certified copy of the order within 30 days with the Secretary of State and the State Registrar and pay the applicable fees. You may write or contact the State Registrar at: California Department of Health Services Office of Vital Records MS 5103, P.O. Box 997410 Sacramento, CA 95899-7410 Phone: (916) 445-2684 Web site: www.dhs.ca.gov Local courts may supplement these instructions. Check with the court to determine whether supplemental information is available. For instance, the court may provide you with additional written information identifying the department that handles name and gender change petitions, the times when petitions are heard, and the newspapers that may be used to publish the Order to Show Cause. NC-200 [Rev. July 1, 2006] PETITION FOR CHANGE OF NAME Page 2 of 2 AND GENDER