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SUPERIOR COURT OF ARIZONA IN __________ COUNTY In the Matter of: Case Number: ORDER CHANGING NAME Applicant (Name of Person Filing Request) FOR A FAMILY THE COURT FINDS: 1. This case has come before this Court to change the legal names of the persons listed below. 2. This Court has jurisdiction to change the legal names of the persons as listed below. 3. Good cause exists to grant this application. 4. It is in the best interest of any minor child(ren) listed below. THE COURT ORDERS: 1. The name on the Birth Certificate or Current Legal Name: First Middle Last Date of Birth: Month Day Year Place of Birth: City Sta te Nation IS CHANGED TO: First Middle Last The name on the Birth Certificate or Current Legal Name: First Middle Last Date of Birth: Month Day Year Place of Birth: City State Nation IS CHANGED TO : First Middle Last For Clerk’s Use Only © S uperior Court of A rizona CVNCF81f 042313 ALL RIGHTS RESERVED Use only most current version ORD Page 1 of 2 Case No. The name on the Birth Certificate or Current Legal Name: First Middle Last Date of Birth: Month Day Year Place of Birth: City State Nation IS CHANGED TO : First M iddle Last The name on the Birth Certificate or Current Legal Name: First Middle Last Date of Birth: Month Day Year Place of Birth: City State Nation IS CHANGED TO : First Middle Last 2. For a pe rson born in the State of Arizona, the Office of Vital Records is ordered to amend the birth record to reflect the new name as ordered above. Note that except for correction of error, a woman’s maiden name as recorded on the birth record , is unaffected by an Order for Change of Name ( or by marriage ). For a person born in a state other than Arizona, to the extent that the agency that maintains birth records in that state is authorized to honor an order of this Court, that agency is requested or ordered to amend its birth records to reflect the new name(s) as ordered above. 3. This Order does not establish paternity or add the name of a father to a birth certificate. 4. This Order does not release the persons named above from any obligation s incurred or harm any rights of property or action in any original name. 5. Other Orders:* *May NOT be used to establish paternity or to add the name of a father to a birth certificate. DONE IN OPEN COURT: Date Judicial Officer © S uperior Court of A rizona CVNCF81f 042313 ALL RIGHTS RESERVED Use only most current version ORD Page 2 of 2