Fill and Sign the Name Change for a Family 1 to Request a Name Change Form

SUPERIOR COURT OF ARIZONA IN __________ COUNTY In the Matter of: Name of Applicant Case Number: ORDER CHANGING NAME OF AN ADULT THE COURT FINDS: 1. This case has come before this Court to change the current legal name of the Applicant. to change the birth record of the Applicant 2. This Court has jurisdiction to change the legal name and/or the Birth Record of the Applicant. 3. Good cause exists to grant the application for change of name. THE COURT ORDERS: 1. The current legal name of the Applicant : First Middle Last Date of Birth: Month Day Year Place of Birth: City State Natio n IS CHANGED TO: First Middle Last For Clerk’s Use Only CVNC81f -021716 © S uperior Court of Arizona ALL RIGHTS RESERVED ORD Page 1 of 2 Case No. ____________________ The Birth record name of the Applicant: First Middle Last Date of Birth: _____________________________________________________ Month Day Year Place of Birth: City State Nation IS CHANGED TO: First Middle Last 2. For a person born in the State of Arizona, the Office of Vital Records is ordered to amend the birth record to reflect the new name as above ordered. For a person born in any other state, 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 as above ordered. 3. This Order does not release the Applicant from any obligations incurred or harm any right s of property or action in any original name. 4. Other orders: DONE IN OPEN COURT: . Date Judicial Officer CVNC81f -021716 © S uperior Court of Arizona ALL RIGHTS RESERVED ORD Page 2 of 2