Fill and Sign the In Name Change Proceeding under Form

NC-410 FOR COURT USE ONLY FAX NO. (Optional): TELEPHONE NO.: E-MAIL ADDRESS (Optional): ATTORNEY FOR (Name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME: PETITION OF (Name of each petitioner): CASE NUMBER: APPLICATION TO FILE DOCUMENTS UNDER SEAL IN NAME CHANGE PROCEEDING UNDER ADDRESS CONFIDENTIALITY PROGRAM (SAFE AT HOME) Before you complete this pe tition, you should read the Information Sheet for Name Change Proceedings Under Address Confidentiality Program (Safe at Home) ( form NC-400-INFO). You must file a Declaration in Support of Application to File Documents Under Seal in Name Change Proceeding Under Address Confidentiality Program (Safe at Home) (form NC-420) with this application. You must file this application and the petition in the superior court of the county where the person whose name is to be changed resides. Petitioner (name): APPLICATION TO FILE DOCUMENTS UNDER SEAL IN NAME CHANGE PROCEEDING UNDER ADDRESS CONFIDENTIALITY PROGRAM (SAFE AT HOME) Form Adopted for Mandatory Use Judicial Council of California NC-410 [New January 1, 2010] Code of Civil Procedure, § 1277; California Rules of Court, rule 2.577 STREET ADDRESS: 1. is a participant in the a. Petition for Change of Name (form NC-100) b. Attachment to Petition for Change of Name (form NC-110) Order to Show Cause for Change of Name (form NC-120) c. g. Declaration in Support of Application to File Docume nts Under Seal in Name Change Proceeding Under Address Confidentiality Program (Safe at Home) (form NC-420) i. Other (specify): Petitioner has completed each of the documents checked above, placed them in a sealed envelope, and is lodging the envelope with the court along with this application. 4. Secretary of State's address confidentiality program under Go vernment Code sections 6205–6211 and is alleging one of the following as a reason for the name change: (1) seeking to avoid domestic violence, (2) seeking to avoid stalking, or (3) is, or is filing on behalf of, a victim of sexual assault. Petitioner requests that the court f ile the following documents under seal: 2. The facts that support this petiti on to file the documents checked above under seal are stated in the Declaration in Support of Application to File Documents Under Seal In Name Change Proceeding Under Address Confidentiality Program (Safe at Home ) (form NC-420). 3. (SIGNATURE OF ATTORNEY OR PETITIONER WITHOUT ATTORNEY) (TYPE OR PRINT NAME) Date: ` CONFIDENTIAL h. Order on Application to File Documents Under Seal in Name Change Proceeding Under Address Confidentiality Program (Safe at Home) (form NC-425) ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): Page 1 of 1 f. Application to File Documents Under Seal in Name Change Proceeding Under Address Confidentiality Program (Safe at Home) (form NC-410) e.Civil Case Cover Sheet (form CM-010) Decree Changing Name (form NC-130) d.