Fill and Sign the Utah Ad Litem Form

_____________________________ (Applicant’s Name) _____________________________ (Address) _____________________________ (City) _____________________________ (Telephone) ____________ DISTRICT COURT, ______________________ COUNTY, UTAH COURT’S ADDRESS: _____________________________________________________ IN THE MATTER OF THE NAME CHANGE OF: ______________________________ , . (minor’s name) APPLICATION FOR APPOINTMENT OF A GUARDIAN AD LITEM A minor. Case No. ____________________ Judge _______________________ My name is __________________________________________, and I am the Applicant. (name of person asking for appointment of guardian ad litem) I ask this court to appoint a guardian ad litem to represent the minor in this name change action. Without a guardian ad litem, the minor’s interests will not be properly represented. I ask that _______________________________________________ be appointed as (name or names of proposed guardian(s) ad litem) guardian ad litem(s) for _______________________________________________________ . (name of minor) Minor’s Name Change: Application for Appointment of G.A.L., p. 1 Approved: November 19, 2004 If a guardian ad litem is appointed: [ ] no costs are anticipated for this guardian ad litem. [ ] I will pay all costs for the guardian ad litem. [ ] the court should justly and equitably apportion costs for the guardian ad litem between the litigants Minor’s Name Change: Application for Appointment of G.A.L., p. 2 Approved: November 19, 2004 DATED: _________________________ __________________________________________ Applicant’s signature NOTARY CLAUSE __________________________, Affiant, is personally known to me or presented satisfactory proof of identity. After being sworn and while under oath, Affiant stated that he or she was acting voluntarily, had read and understood the preceding document, and that the contents were true. Affiant then signed the document in my presence. Signed on _________________, 20____. X_________________________________________ Notary Public/Court clerk (Notary Seal) CERTIFICATE OF DELIVERY On _________________________ (date) , I [ ] hand-delivered, [ ] mailed by first class mail, postage prepaid, a copy of the foregoing APPLICATION FOR APPOINTMENT OF GUARDIAN AD LITEM to: Name: Address: Name: Minor’s Name Change: Application for Appointment of G.A.L., p. 3 Approved: November 19, 2004 Address: Name: Address: ____________________________________ Applicant Minor’s Name Change: Application for Appointment of G.A.L., p. 4 Approved: November 19, 2004