Fill and Sign the Optional Consent of Other Form

Person Filing: Address (if not protected): City, State, Zip Code: Telephone: Email Address: Lawyer’s Bar Number: Representing Self, without a Lawyer or Attorney for Petitioner OR Respondent SUPERIOR COURT OF ARIZONA IN ____________ COUNTY In the Matter of : Case Number: OPTIONAL CONSENT OF OTHER PARENT TO NAME CHANGE OF A MINOR CHILD AND WAIVER OF NOTICE (You may submit a Notari zed Waiver or serve notice and provide proof to the court, but you must do one or the other) a Minor RE QUIRED INFORMATION FROM PARENT NOT FILING FOR NAME CHANGE, UNDER OATH OR AFFIRMATION: 1.INFORMATION ABOUT ME: Name: Address: Telephone: Date of Birth: Month Date Year Place of Birth: City StateNation FOR CLERK USE ONLY © Superior Court of Ar izona CVNC17 f – 092917 ALL RIGHTS RESERVED Page 1 of 2 Use only most current version Case No.____________________ 2. I have read the Application for Name Change and consent to changing the child’s LEGAL nam e to: First Middle Last 3.I waive notice of all further proceedings in this matter. UNDER OATH OR BY AFFIRMATION I swear or affirm under penalty of perjury that the contents of this document are true and correct to the best of my knowledge and belief. Date (Non -Petitioning) Parent's Signature Printed Name STATE OF COUNTY OF Subscribed and sworn to or affirmed before me this: by (date) . (notary seal) Deputy Clerk or Notary Public © Superior Court of Ar izona CVNC17 f – 092917 ALL RIGHTS RESERVED Page 2 of 2 Use only most current version