Application For Change Of Name For A Minor Child {CVNCM11F}

Person Filing Document: Street Address: City, State, Zip Code: Telephone Number: Represented by Self (No Attorney), or by Attorney If Attorney, State Bar Number: FOR CLERK USE ONLY SUPERIOR COURT OF ARIZONA IN In the Matter of: Case Number: COUNTY APPLICATION FOR CHANGE OF NAME FOR A MINOR CHILD (ARS 12-601) A Minor STATEMENTS TO THE COURT, UNDER OATH OR AFFIRMATION 1. INFORMATION ABOUT ME, THE APPLICANT (Adult) First Address Date of Birth Month County of Residence Place of Birth City 2. State Nation Day Year Middle Last INFORMATION ABOUT THE MINOR FOR WHOM THIS NAME CHANGE IS REQUESTED: Name on Birth Certificate First Address: Date of Birth: Middle Last Month County of Residence: Relationship to Applicant: Place of Birth: Day Year © ARIZONA SUPREME COURT ALL RIGHTS RESERVED CVNCM11F-072607 PAGE 1 OF 2 American LegalNet, Inc. www.FormsWorkFlow.com Case Number: 3. I ASK THAT THE LEGAL NAME BE CHANGED TO: First 4. Middle Last I ASK THAT THE BIRTH RECORDS BE MODIFIED TO REFLECT THE NAME LISTED ABOVE. 5. I REQUEST THAT THE LEGAL NAME BE CHANGED FOR THE FOLLOWING REASON: ADDITIONAL STATEMENTS I understand that this name change does not establish paternity and will not cause a father's name to be added to a birth certificate. This application is made solely for the best interest of the minor child named above. It will not release the person from any obligations incurred or harm any rights of property or action in any original name. OATH OR AFFIRMATION OF APPLICANT The contents of this document are true and correct to the best of my knowledge and belief. Signature Acknowledged before me this date: Date Seal/My Commission expires Notary Public or Deputy Clerk © ARIZONA SUPREME COURT ALL RIGHTS RESERVED CVNCM11F-072607 PAGE 2 OF 2 American LegalNet, Inc. www.FormsWorkFlow.com