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(In str u ctio ns o n n ext p age ) P ETIT IO N F O R C HANG E O F N AM E Code o f C iv il P ro ce dure , § 1 275 e t s e q. F orm A dopte d fo r M andato ry U seJ u d ic ia l C ouncil o f C alif o rn iaN C -1 00 [R ev. J u ly 1 , 2 004] (C han ge o f N am e) NC-100 PETITIONER OR PARTY WITHOUT ATTORNEY (Name, state bar number, and address): TE LE PH O NE N O . FA X N O .( O ptio nal) : E-M AIL A D DRESS ( O ptio nal) : ATTO RN EY F O R ( N am e): SUPERIOR COURT OF CALIFORNIA, COUNTY OF STREET ADDRESS MAILING ADDRESS CITY AND ZIP CODE BRANCH NAME PETITION OF (Names of each petitioner) : FO R C O URT U SE O NLY PETITION FOR CHANGE OF NAME CASE NUMBER: Befo re y o u c o m ple te th is p etit io n, y o u s h ould r e ad th e In str u ctio ns fo r F ilin g a P etit io n fo r C han ge o f N am e o n th e n ext p ag e. Y ou m ust
an sw er a ll q uestio ns a n d c h eck a ll b oxes o n th is p etit io n th at a p ply to y o u. Y ou m ust file th is p etit io n in th e s u perio r c o urt o f th e c o unty
wh ere t h e p ers o n w hose n am e is t o b e c h an ged r e sid es.1. Petitioner (name): resides in this county.2. Petitioner requests that the court decree the following name changes (list every name that you are seeking to change): Present name Proposed name a. changed to b. changed to c. changed to d. changed to C ontin ued ( if y o u a re s e ekin g to c h ange a ddit io nal n am es, y o u m ust p re pare a lis t a nd a tta ch it to th is p etit io n a s A tta ch m ent 2 ). 3. Petitioner requests that the court issue an order directing all interested persons to appear and show cause why this petition for
change of name of the persons identified in item 2 should be granted.4. The number of persons under 18 years of age whose names are to be changed is (specify) : 5. If this petition requests the change of name of any person or persons under 18 years, this request is being made bya. both p are nts . b . m oth er o nly . c . fa th er o nly . d . near r e la tiv e ( n am e a nd r e la tio nsh ip ): e. g uard ia n ( n am e): f. o th er ( s p ecif y ): 6. For e ach p ers o n w hose n am e is t o b e c h anged, p etit io ner p ro vid es t h e f o llo w in g in fo rm atio n ( y o u m ust a tta ch a c o m ple te d c o py
of the attachment Name and Information About the Person Whose Name Is to Be Changed (Form NC-110) for each person
identified in item 2):a. The number of attachments included in this petition is (specify number): b -f. (A tta ch m ent p age o r p ages)
PETIT IO N F O R C HANG E O F N AM E NC -1 00 [R ev. J u ly 1 , 2 00 6] (C han ge o f N am e) IN STR UCTIO NS F O R F IL IN G A P ETIT IO N FO R C HANG E O F N AM E 1. Where t o F ile T he p etit io n f o r c h ange o f n am e m ust b e f ile d in t h e s u perio r c o urt o f t h e c o unty w here t h e p ers o n w hose n am e is t o b e
changed p re se ntly liv e s.2. Whose N am e M ay B e C han gedT he p etit io n m ay b e u se d t o c h ange o ne's o w n n am e a nd, u nder c e rta in c ir c u m sta nce s, t h e n am es o f o th ers ( e .g ., c h ild re n u nder
18 y e ars o f a ge).3 . What F orm s A re R eq uir e dP re pare a n o rig in al a nd t w o c o pie s o f e ach o f t h e f o llo w in g d ocu m ents :a. Petit io n f o r C hange o f N am e ( F orm N C-1 00).b . Nam e a nd I n fo rm atio n A bout t h e P ers o n W hose N am e I s t o B e C hanged ( A tta ch m ent t o P etit io n) ( fo rm N C-1 1 0) ( a tta ch a s
ma ny c o pie s a s n ece ssa ry ).c . Ord er t o S how C ause f o r C hange o f N am e ( F orm N C-1 20).d. Decre e C hangin g N am e ( F orm N C-1 3 0 o r, f o r g uard ia ns, F orm N C-1 3 0G ).In a ddit io n, a g uard ia n m ust p re pare a nd a tta ch a D ecla ra tio n o f G uard ia n ( S upple m enta l A tta ch m ent t o P etit io n) ( F orm N C-1 1 0G )
fo r e ach c h ild w hose n am e is t o b e c h anged.4 . Filin g a n d F ilin g F eeP re pare a n o rig in al C iv il C ase C ove r S heet ( F orm C M -0 10). F ile t h e o rig in al p etit io n a nd C iv il C ase C ove r S heet w it h t h e c le rk o f
th e c o urt a nd o b ta in t w o f ile d-e ndo rs e d c o pie s o f t h e p etit io n. A f ilin g f e e w ill b e c h arg ed u nle ss y o u q ualif y f o r a f e e w aiv e r.(If y o u w ant t o a pply f o r a f e e w aiv e r, s e e A pplic a tio n f o r W aiv e r o f C ourt F ees a nd C osts ( fo rm 9 82(a )(1 7)) ; I n fo rm atio n S heet o n
Waiv e r o f C ourt F ees a nd C osts ( fo rm 9 82(a )(1 7)(A )-IN FO ; a nd O rd er o n A pplic a tio n f o r W aiv e r o f C ourt F ees a nd C osts ( fo rm
982(a )(1 8).)5 . Req uestin g a C ourt H earin g D ateY ou s h ould r e qu est a d ate f o r t h e h earin g o n t h e O rd er t o S how C ause a t le ast s ix w eeks in t h e f u tu re .6. Filin g t h e O rd er t o S how C au seA fte r t h e h earin g d ate h as b een in clu ded a nd y o u h ave o bta in ed a ju dge's s ig natu re o n t h e O rd er t o S how C ause , f ile t h e o rig in al
or d er in t h e c le rk 's o ffic e a nd o bta in f ile d-e ndors e d c o pie s o f t h e o rd er.7. Publis h in g t h e O rd er t o S how C au seA c o py o f t h e O rd er t o S how C au se m ust b e p ublis h ed in a lo ca l n ew sp aper o f g enera l c ir c u la tio n o nce a w eek f o r a t l e ast f o ur
co nsecu tiv e w eeks b efo re t h e d ate o f t h e h earin g o n t h e n am e c h ange p etit io n. T he p etit io ner s e le cts t h e n ew sp aper f r o m
among t h ose n e w sp apers le gally q ualif ie d t o p ublis h o rd ers a nd n otic e s. T he n ew sp aper u se d m ust f ile a P ro of o f P ublic a tio n w it h
th e s u perio r c o urt b efo re t h e h earin g. I f n o n ew sp aper o f g enera l c ir c u la tio n is p ublis h ed in t h e c o unty , t h e c o urt m ay o rd er t h e
Ord er t o S how C ause t o b e p oste d b y t h e c le rk .8. Nam e C han ge f o r C hild re na. If a p etit io nin g p are nt is r e questin g t h e n am e c h ange f o r a c h ild u nder 1 8 y e ars o f a ge, a nd o ne o f t h e p are nts , if liv in g, d oes
no t jo in in c o nse ntin g t o t h e n am e c h ange, t h e p etit io nin g p are nt m ust h ave a c o py o f t h e O rd er t o S how C ause o r n otic e o f
th e t im e a nd p la ce o f t h e h earin g s e rv e d o n t h e n onco nse ntin g p are nt. S erv ic e m ust b e m ade a t l e ast 3 0 d ays p rio r t o t h e
hearin g u nd er C ode o f C iv il P ro ce dure s e ctio n 4 13.1 0, 4 14.1 0, 4 15.1 0, o r 4 15.4 0.b. If t h e n on-c o nse ntin g p are nt r e sid es in C alif o rn ia , t h e o rd er o r n otic e m ust b e p ers o nally s e rv e d o n t h e n onco nse ntin g p are nt.
Th e p etit io nin g p are nt c a nnot p ers o nally s e rv e t h is d ocu m en t.c . If t h e n onco nse ntin g p are nt r e sid es o uts id e C alif o rn ia , h e o r s h e m ay b e s e rv e d b y s e ndin g a c o py o f t h e o rd er o r n otic e b y
fir s t- c la ss m ail, p osta ge p re p aid , r e tu rn r e ce ip t r e queste d.d. If a p etit io n t o c h ange t h e n am e o f a c h ild h as b een f ile d b y a g uard ia n, t h e g uard ia n m ust ( 1 ) p ro vid e n otic e o f t h e h earin g t o
any liv in g p a re nt o f t h e c h ild b y p ers o nal s e rv ic e a t le ast 3 0 d a ys b efo re t h e h earin g, o r ( 2 ) if e it h er o r b oth p are nts a re
de ce ase d o r c a nnot b e lo ca te d, s e rv e n otic e o f t h e h earin g o n t h e c h ild 's g ra ndpare nts , if liv in g, n ot le ss t h an 3 0 d ays b efo re
the h earin g u nder C ode o f C iv il P ro ce dure s e ctio n 4 13.1 0, 4 1 4.1 0, 4 15.1 0, o r 4 15.4 0.If y o u h ave s e rv e d a p are nt o r g ra ndpare nt, f ile a c o py o f t h e c o m ple te d P ro of o f S erv ic e o f O rd er t o S how C ause ( fo rm N C-1 21)
wit h t h e c o urt b efo re t h e h earin g.9. Dom estic V io le n ce C onfid en tia lit y P ro gra mIn c a se s w here t h e p etit io ner is a p artic ip ant in t h e d om estic v io le nce c o nfid entia lit y p ro gra m , t h e p etit io n f o r n am e c h ange, t h e
ord er t o s h ow c a use p ublis h ed in t h e n ew sp ap er, a nd t h e d ecre e s h ould , in ste ad o f g iv in g t h e p ro pose d n am e, in dic a te t h at t h e
na m e is c o nfid entia l a nd o n f ile w it h t h e S ecre ta ry o f S ta te .10. Court HearingBrin g c o pie s o f a ll d ocu m ents t o t h e h earin g. I f t h e ju dge g ra nts t h e n am e c h ange p etit io n, t h e ju dge w ill s ig n t h e o rig in al d ecre e.11. If y o u w ant t o a m end a b ir th c e rtif ic a te t o s h ow t h e n am e c h an ge, y o u s h ould c o nta ct t h e f o llo w in g o ffic e : C alif o rn ia D ep artm en t o f H ealt h S erv ic es O ffic e o f V it a l R eco rd sM S 5 103, P .O . B ox 9 97410S acra m en to , C A 9 589 9-7 410 P hone: ( 9 16) 4 45-2 684W eb s it e : w ww.d hs.c a.g ov Loca l c o u rts m ay s u pple m ent t h ese in str u ctio ns. C heck w it h t h e c o urt t o d ete rm in e w heth er s u pple m enta l in fo rm atio n is a va ila ble .
Fo r in sta nce , t h e c o urt m ay p ro vid e y o u w it h a ddit io nal w rit te n in fo rm atio n a bout w hat d epartm ent h andle s n am e c h ange p etit io ns,
th e t im es w hen p etit io ns a re h ea rd , a nd w hic h n ew sp apers t h at m ay b e u se d t o p ublis h t h e O rd er t o S how C ause .
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