Fill and Sign the Pg 605 State of Alaska Form

Page 1 of 2 CIV- 694 ( 6/15 )(cs) Civil Rule 84(e) PETITION TO CHANGE CHILD’S NAME AS 09.55.010 Person Filing Petition: Name: Telephone No. Address: IN T HE SUPERIOR COURT FOR THE STATE OF ALASKA AT In th e Matter of a Change of Name for: ) ) , ) A Minor Child (current legal name) ) Date of Birth , ) ) CASE N O. CI By: , ) Petitioner (parent or legal guardian) ) PETITION TO ) CHANGE CHILD’S NAME Peti tioner requests that the Court change the name of the minor child as follows: 1. The minor child’s current legal name is First Name Middle Name Last Nam e 2.I wish the child to take and be legally known by a new name, which is: First Name Middle Name Last Name 3.I am the minor child’s legal mother father guardian. 4. Consent to thi s name change by the minor child’ s: mother father Name of Non -Petitioning Parent is attached. is not attached. is not necessary because: this parent is deceased. A certified copy of th e child’s birth certificate and the parent’s death certificate are attached. parental rights were terminated on in a court in the state of other: 5. The reasons for this request are: Page 2 of 2 CIV- 694 ( 6/15 )(cs) Civil Rule 84(e) PETITION TO CHANGE CHILD’S NAME AS 09.55.010 6.This name change is sought for personal reasons and not to avoid judgments, debts, obligations, or to defraud any person. The reasons stated are consistent with the public interest. VERIFICATION I state on oath or affirm that I have read this document and believe all statements made in it are true. Da te Petitioner’s Signature P rinted Name Subscribed and sworn to or affirmed before me at , Alaska on . (Da te) Cl erk of Court, Notary Public or other person (SEAL) authorized to administer oaths. My commission expires: