Fill and Sign the Idaho Name Change 497305760 Form

Full Name of Party Filing Document Mailing Address (Street or Post Office Box) City, State and Zip Code Telephone Email Address (if any) IN THE DISTRICT COURT FOR THE JUDICIAL DISTRICT FOR THE STATE OF IDAHO, IN AND FOR THE COUNTY OF IN RE: Legal name of child Case No. PETITION FOR NAME CHANGE (Minor) Fee Category: Filing Fee: Complete Section A, B, or C based on who is filing the petition. I certify: A. Both Parents are Filing the Petition Together 1. We are the p a r en ts o f t h e abo v e c h il d, and are filing this petition together . Our f u l l l e g a l na mes an d r e s i den ces a re: Name: Address: Name: Address: B. Only One Parent Is Filing the Petition 1. I am a parent of the above child, and I am filing this petition without the other parent. My full PETITION FOR NAME CHANGE (Minor) Page 1 CAO NCM 1-1 07/01/2017 legal name and residence are listed above. 2.  a. T h e c h il d ’ s other parent i s li v i n g; the other parent’s name and address are: Name: Address:  The address is unknown.  b. The child’s other parent is deceased. C. A Guardian Is Filing the Petition 1. I am filing this petition as the guardian of the child. My f u l l l e g a l na me an d r e s i den ce are listed above. 2. Child’s Parents’ Information a . T h e c h il d ’ s  f a t h e r  mother i s li v i n g, his/her name and address are: Name: Address:  The address is unknown. b . T h e c h il d ’ s  f a t h e r  m o t h e r i s li v i n g , his/her name and address are: Name: Address:  The address is unknown. c.  T h e c h il d ’ s  f a t h e r  mother i s deceased. 3.  Child’s Grandparent’s Information (if applicable) Only list information about the child’s grandparents if one of the following is true:  I am a guardian, and one or both of the parents’ addresses are unknown,  I am a guardian, and b oth of the child’s parents are deceased, The na m e( s) an d add r e ss( e s) o f the child’s living grandparents are : PETITION FOR NAME CHANGE (Minor) Page 2 CAO NCM 1-1 07/01/2017 . D. Child’s Information 1. T h e c h il d w a s bo rn o n ( d ate) , , i n t h e c i t y o f , c oun t y o f , s t a t e o f , and r e s i de s a t . 2. T h e c h il d ’ s na me should be changed t o The reason I want to change the child’s name is: . 3. T h e na me c ha n g e i s no t t o a v o i d cr ed i t o r s o r ou t s t and i n g de b t s. T h e c h il d i s no t r e q u i r ed t o r e g i s t e r a s a c on v i c t e d s e x ua l o f f end e r unde r C hap t e r 8 3 , T i t l e 18 , I dah o C ode , o r unde r t h e p r o v i s i on s o f s i m il a r l a w s ena c t e d b y a n o t he r s t a t e. 4. I ask that a Deputy Clerk of the Court Issue a Notice of Hearing in this case to be published for four (4) successive weeks in (newspaper name) Newspaper, designated by the court as most likely to give notice in: County, the County where the child resides (visit http://www.courtselfhelp.idaho.gov/name-changes for a list of newspapers by county). WHEREFORE, I a s k t h a t t h e J u d g e s i g n a Judgment c h a n g i n g t h e c h il d ’ s na me a s I ha v e a s k e d . CERTIFICATION UNDER PENALTY OF PERJURY I certify under penalty of perjury pursuant to the law of the State of Idaho that the foregoing is true and correct. Date: Typed/printed name Signature PETITION FOR NAME CHANGE (Minor) Page 3 CAO NCM 1-1 07/01/2017 PETITION FOR NAME CHANGE (Minor) Page 4 CAO NCM 1-1 07/01/2017