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1 1 23 4 56789 10 11 1213141516171819202122232425 ORDR(Your name) (Address) (Telephone) In Proper Person DISTRICT COURT ____________ COUNTY, NEVADA In the Matter of the )Application of:)CASE NO: ) )DEPT. NO. (Your name) ) ) and) ) ) (Your spouse’s name) ) ) for Change of Name for Themselves and )for the Minor Children ) )) (First child’s name)) ) and) )(Second child’s name) ) ) ORDER FOR CHANGE OF SURNAMES This matter having come on for (check one) hearing/ summary disposition in the 2 1 23 4 56789 10 11 1213141516171819202122232425 Family Division of the ____________ Judicial District Court, County of ____________; and the Court being fully advised in the premises, both as to subject matter as well as the party thereto, and that jurisdiction is proper in Nevada and good cause appearing therefore;IT IS HEREBY ORDERED, ADJUDGED AND DECREED that (your name) , born on , in (city and state) , name be changed to .IT IS FURTHER ORDERED that (spouse’s name or “N/A”) , born on , in (city and state) name be changed to . IT IS FURTHER ORDERED that (first child’s name) , born on , in (city and state) name be changed to .IT IS FURTHER ORDERED that (second child’s name or “N/A”) , born on , in (city and state) , name be changed to .IT IS FURTHER ORDERED that the Department of Vital Statistics shall issue a newbirth certificate for Petitioner (your name) withthe name of (your new name) .IT IS FURTHER ORDERED that the Department of Vital Statistics shall issue a newbirth certificate for Co-Petitioner (spouse’s name or “N/A”) 3 1 23 4 56789 10 11 1213141516171819202122232425 with the name of (spouse’s new name) . .IT IS FURTHER ORDERED that the Department of Vital Statistics shall issue a newbirth certificate for (first child’s name) withthe name of (child’s new name) .IT IS FURTHER ORDERED that the Department of Vital Statistics shall issue a newbirth certificate for (second child’s name or “N/A”) with the name of (child’s new name) .DATED this ______ day of (month) ________________, _____________. ____________________________________ DISTRICT COURT JUDGE Respectfully submitted:(Your signature) (Your name) (Address) (Telephone) Petitioner in Proper Person (Spouse’s signature) (Spouse’s name) (Address) (Telephone) Co-Petitioner in Proper Person