Fill and Sign the Order Granting Name Change Eforms

NDLSHC Page 1 of 3 NC Pet/Rev. Sep 2017 IN DISTRICT COURT, COUNTY, NORTH DAKOTA Case No. IN THE MATTER OF THE PETITION FOR A NAME CHANGE OF (f ull name of Petitioner ) PETITION FOR NAME CHANGE Pursuant to North Dakota Century Code Section 32-28 -02, _________________________________________________________ ( current full , legal name ), Petitioner, respectfully petitions the Court for a change of name, and respectfully states to the Court as follows: 1. Petitioner’s full, legal name is ( current f ull , legal name ): __________________________________________ ___________________________________. 2. Petitioner currently reside s at _______________________________________________, ( address ) ___________________ _____________, (city) __________________________ County , North Dakota __________ (zip code ). 3. Petitioner has been a resident of __________________________ County, North Dakota for at least six months prior to the filing of this Petition. 4. Petitioner is a citizen / permanent resident alien ( choose one) of the United States. 5. Petitioner is 18 years o f age o r older . 6. Petitioner d esires to change his/her name to: ( requested full legal name ) __________________________________________________________________________. 7. The reasons Petitioner is seeking a name change are stated in the Affidavit of Petitioner, which is filed with this Petition for Name Change and incorporated by reference. NDLSHC Page 2 of 3 NC Pet/Rev. Sep 2017 8. Criminal History: ( choose one) Petitioner has never been convicted of a crime. ( OR ) Petit ioner has been convicted of a crime or crimes under state or federal law. Detailed information is provided in the Affidavit of Petitioner accompanying this petition. 9. The requested name change is made in good faith and not for the purpose to defraud or mislead . The request will not cause injury to any individual or compromise public safety . 10. Notice: ( choose one ) A Notic e of Petition for Name Change was published on ________________________, 20_____, in the ________________________________________________ ( newspaper), the official newspaper in _____________________________ County, North Dakota , where P etitioner resides . The affidavit of publication is filed with the court . (OR) Petitione r requests that the court waive publication of the Notice of Petition for Name Change because ( a j udge MAY waive publication of the Notice. If you want the judge to waive the publication of the Notice of Petition for Name Change, check the reason below. ) Petitioner is only requesting a change of a first or middle name. Petitioner is a victim of domestic violence as defined in NDCC 14 -07.1 -01. A detailed statement is provided in the Affidavit of Petitioner accompanying this petition. 11. Objections to Petition for Name Change: ( choose one) No written objectio ns to the Petition for Name Change were given to the Petitioner within thirty (30) days of publication of the Notice of Petition for Name Change. (OR) NDLSHC Page 3 of 3 NC Pet/Rev. Sep 2017 Written objections to the Petition for Name Change were given to the Petitioner. The written objections accompany this petition. (OR) Petitioner is requesting that the court waive publication of the Notice of Petition for Name Change. Notice of the petition has not been published. 12. There is no just cause to deny this Petition for Name Change. WHEREFORE , Petitioner requests an order of this court granting that the legal name of the Petitioner be changed from ________________________________ ____________________ to _____________________________________________ ______________________________. Dated this _________ day of ___________ ___________, 20______ ________________________________________ _______________ PETITIONER ( signature) ________________________________________ _______________ ( type or print your name ) ________________________________________ _______________ ( type or print your address ) ________________________________________ _______________ ( type or print your city, state, zipcode ) ________________________________________ _______________ ( type or print your telephone number )