Legal Change Petition and Final Order

LEGAL CHANGE PETITION AND FINAL ORDER

IN THE COURT OF COUNTY, . Case No.:

Petitioner Name: Current Legal Name:

Proposed New Legal Name: Date of Birth:

RECITALS

WHEREAS, Petitioner, identified above, is a resident of County, , and seeks a judicial change of legal name pursuant to applicable law; and

WHEREAS, Petitioner has filed a sworn petition setting forth the factual basis and reasons supporting the requested change, has complied with notice and publication requirements as reflected in the court file, and has represented that no purpose of fraud, evasion of obligations, or concealment of identity is intended by the change; and

WHEREAS, the Court conducted a hearing on at which evidence was received and the Court made findings as set forth below;

NOW THEREFORE

The Court makes the following findings and issues the following order:

1. FINDINGS OF FACT

1.1 Petitioner, , was born on in .

1.2 The Court finds that the allegations in the petition are true and that the requested change of name from to is not sought for any improper or unlawful purpose.

2. STATEMENT OF GROUNDS

2.1 Petitioner declares under penalty of perjury that the facts set forth in the petition and supporting affidavits are true and correct and that no creditor, governmental entity, or third party will be defrauded by the requested change.

3. NOTICE, SERVICE, AND BACKGROUND CHECKS

3.1 The Court finds that notice to interested parties and publication requirements were satisfied as indicated in the record on .

3.2 Petitioner has disclosed prior criminal convictions or affirmatively stated none exist: No prior convictions Prior convictions disclosed in petition

4. ORDER

4.1 IT IS HEREBY ORDERED that the petition for change of legal name is GRANTED. Petitioner’s name is changed from to .

4.2 The Court directs all government agencies, financial institutions, educational institutions, and other record holders to accept the new legal name for all purposes and to update their records accordingly upon presentation of a certified copy of this Order.

4.3 The Clerk of Court shall prepare and issue a certified copy of this Order upon request and shall retain a copy in the court file. If sealing of the file is requested, it shall be processed in accordance with applicable statutory standards and the Court’s separate sealing order.

5. EFFECTIVE DATE

5.1 This Order shall take effect on entry by the Clerk of Court, which shall be the effective date of the legal name change for all legal and administrative purposes unless otherwise ordered by the Court.

6. MISCELLANEOUS

6.1 Notices: Any notice required under this Order or petition shall be given to Petitioner at the following address:

6.2 Amendments: This Order may be amended by further order of this Court upon noticed motion and good cause shown.

6.3 Waiver: No waiver of any provision of this Order shall be effective unless in writing and signed by the party waiving the provision and approved by the Court.

GOVERNING LAW; ENTIRE AGREEMENT; SEVERABILITY

This Order is entered pursuant to the laws and procedures of the State of . This Order constitutes the final and entire adjudication of the petition for change of name; all prior pleadings are merged herein. If any provision of this Order is held invalid, such invalidity shall not affect the remaining provisions, which shall remain in full force and effect.

CERTIFICATION

Petitioner certifies under penalty of perjury that the information contained in the petition and supporting documents is true and correct. Petitioner acknowledges that this Court retains jurisdiction to enforce and interpret this Order.

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