Fill and Sign the Use This Form If Your Child is at Least 14 Years Old

1 2 3 4 5 6 7 8 9 10 1112 13 1415 16 17 18 19 20 21222324 25 26 2728 USE THIS FORM IF YOUR CHILD IS AT LEAST 14 YEARS OLD 1 2 3 4 5 6 7 8 9 10 1112 13 1415 16 17 18 19 20 21222324 25 26 2728 GAL(Your name) (Address) (Telephone) In Proper Person DISTRICT COURT __________ COUNTY, NEVADA In the Matter of the )CASE NO.: _______________Application of: ) )DEPT. NO.: _______________ ) )) and ) ) ) )) for Change of Name of the )Minor Child) ) ) )) and ) ) ) ) ) APPLICATION FOR APPOINTMENT AS GUARDIAN AD LITEM COMES NOW, Applicants, _________________________, ____________________________________, pursuant to NRS 12.050, for their motion to have ____________________ be appointed as Guardian Ad Litem, respectfully show:I. Applicant _________________________________________________________________ is at least 14 years old. 1 2 3 4 5 6 7 8 9 10 1112 13 1415 16 17 18 19 20 21222324 25 26 2728 II. _____________________________________________ is a competent person, a resident of ________ County, Nevada, at least 18 years old, and is willing to act as Guardian Ad Litem to appear and prosecute said action for the name change on behalf of the applicants.III.No general guardian, conservator, or other fiduciary has ever been appointed on behalf of the child and the child is not ward of any court.WHEREFORE, Applicants pray to have ___________________________ be appointed as the Guardian Ad Litem for __________________________ to appear and prosecute an action for a change of name on the minor child’s behalf and to act for the child for the purpose of this action. DATED this _____ day of___________,______.Respectfully Submitted:________________________Signature________________________Print Name________________________ ________________________Address ________________________TelephoneIn Proper Person________________________ Child’s signature ________________________Print name________________________ ________________________Address ________________________ Telephone In Proper Person 1 2 3 4 5 6 7 8 9 10 1112 13 1415 16 17 18 19 20 21222324 25 26 2728 VERIFICATION STATE OF NEVADA ) ) ss: COUNTY OF ________ )________________________________, under penalties of perjury, being first duly sworn, deposes and says:That he is the Applicant in the above-entitled action; that he has read the foregoing Application for Appointment as Guardian Ad Litem and knows the contents thereof; that the same is true of his own knowledge, except for those matters therein contained stated upon information and belief, and as to those matters, he believes them to be true.DATED this _____ day of ____________,_____.By:______________________Signature______________________Print NameSUBSCRIBED and SWORN to beforeme this ______ day of___________, ______.__________________________NOTARY PUBLIC 1 2 3 4 5 6 7 8 9 10 1112 13 1415 16 17 18 19 20 21222324 25 26 2728 ACKNOWLEDGMENT STATE OF NEVADA ) )ss: COUNTY OF __________ )On this ________ day of _________________________, ________, before me, the undersigned Notary Public in and for the said County and State, personally appeared _________________________________, known to me to be the person described in and who executed the foregoing Application for Appointment as Guardian Ad Litem, and who acknowledged to me that he did so freely and voluntarily and for the uses and purposes therein mentioned.WITNESS my hand and official seal.___________________________________NOTARY PUBLIC 1 2 3 4 5 6 7 8 9 10 1112 13 1415 16 17 18 19 20 21222324 25 26 2728 VERIFICATION STATE OF NEVADA ) ) ss: COUNTY OF ________ )________________________________, under penalties of perjury, being first duly sworn, deposes and says:That he is the Applicant in the above-entitled action; that he has read the foregoing Application for Appointment as Guardian Ad Litem and knows the contents thereof; that the same is true of his own knowledge, except for those matters therein contained stated upon information and belief, and as to those matters, he believes them to be true.DATED this _____ day of ____________,_____.By:______________________Signature______________________Print NameSUBSCRIBED and SWORN to beforeme this ______ day of___________, ______.__________________________NOTARY PUBLIC 1 2 3 4 5 6 7 8 9 10 1112 13 1415 16 17 18 19 20 21222324 25 26 2728 ACKNOWLEDGMENT STATE OF NEVADA ) )ss: COUNTY OF __________ )On this ________ day of _________________________, ________, before me, the undersigned Notary Public in and for the said County and State, personally appeared _________________________________, known to me to be the person described in and who executed the foregoing Application for Appointment as Guardian Ad Litem, and who acknowledged to me that he did so freely and voluntarily and for the uses and purposes therein mentioned.WITNESS my hand and official seal.___________________________________NOTARY PUBLIC