Fill and Sign the District Court County Nevada Order for Change of Name it Form

© 2017 Nevada Supreme Court Order for Adult Name Change Your Name: ________________________ Address: ___________________________ City, State, Zip: _____________________ Phone: ____________________________ Email: ____________________________ Self-Represented Petitioner DISTRICT COURT ______________________ COUNTY, NEVADA In the Matter of the Application of: ___________________________________ ( print the old name you do not want anymore ) For Change of Name. CASE NO.: ____________________ DEPT: _____________________ ORDER FOR CHANGE OF NAME This Order was submitted ( ☒ check one )  after a hearing  without a hearing before the above-entitled cour t, and after a review of the pleadings and papers on file and the testimony given, if any, and good cause appearing therefore: IT IS ORDERED that the name of the Petitioner, who was born on ( date of birth) _____________________ in ( city) _______________________ ( state) ____________________ be legally changed from ( old ) _____________________ ______________________ _______________________ ( first) ( middle) ( last) to ( new ) _____________________ ______________________ ______________________ ( first) ( middle) ( last) IT IS FURTHER ORDERED that the Clerk transmit a certified copy of this order to the State Registrar of Vital Statis tics. A new birth certificate ( ☒ check one )  shall  shall not be issued reflecting the name change above. Page 2 of 2 - Order for Adult Name Change (the judge may check this box if applicable )  IT IS FURTHER ORDERED that (if the box is checked ) the Clerk transmit a certified copy of th is order to the Central Repository for Nevada Records of Criminal Hist ory for inclusion in the Petitioner’s record of criminal history. DATED this (day) ______ day of (month) ______________, 20____. ____________________________________ DISTRICT COURT JUDGE Submitted By: (your signature )  _______________________________ (print your name) _______________________________