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PETITION OF (Name of petitioner or petitioners): FOR CHANGE OF NAME
CASE NUMBER:
NC-110
NAME AND INFORMATION ABOUT THE PERSON WHOSE NAME IS TO BE CHANGED
Attachment to Petition (form NC-100 or form NC-200)
Attachment
of
(You must use a separate attachment for each person whose name is to be changed. If petitioner is a guardian of a minor, a supplemental attachment, Declaration of Guardian (form NC-110G), must also be completed and attached for each minor whose name is to be changed.) 6. (Continued) Petitioner applies for a decree to change the name of the following person: Self Other b. (1) Present name (specify): Docket No. (specify): (2) Proposed name Short Title: (3) Born on (date of birth): over 18 years of age and presently under 18 years of age NOTICE OF APPEARANCE (4) Born at (place of birth): Appearance for (5) Sex (as stated on original birth(provide name of party): certificate): Male Female (6) Current residence address (street, city, county, and zip code): Status of Party: c. Reason for name
( ) Appellant/Petitioner ( ) Appellee/Respondent change (explain): ( ) Cross-Appellant/Cross-Petitioner ( ) Other (Specify): ( ) An attorney will argue this appeal. ( ( ( ) Cross-Appellee/Cross Respondent ) Intervenor ) Amicus Curiae
< Name of person whose name will be other than d. Relationship of the petitioner to theattorney who will argue appeal, ifchanged: counsel of record: < Date of arguing attorney’s admission to this Court (month, day, year): near relative (indicate relationship): (4) (1) self < Other Federal/State Bar admissions: (month, day, year): parent (5) (2) other (specify): guardian ( ) I am a pro se litigant who is not an attorney. (3) e. If the person whose (name will be changedprounder 18 years of age, provide the names and addresses, if known, of the following ) I am an incarcerated is se litigant. persons: TIME REQUEST Oral argument is not desired. (address): (1) Father (name): ( ) Oral argument is desired. Party(address): requests minutes or multi-co-parties (2) Mother (name): ( ) request a total of minutes to be apportioned as follows: (3) (Only if neither parent is living) Near relatives (names, relationships, and addresses):
If more than 20 minutes per side is requested, set forth reasons:
f.
If the person whose name will be changed is 18 years of age or older, that person must sign the following declaration: AVAILABILITY OF COUNSEL/PRO SE LITIGANT
I understand that the person who will argue the appeal must be ready at any time during or after the week of argument
DECLARATION
I declare under penalty ofwhich appears on thelaws of theorder. of California that perjury under the scheduling State I am not I am under the jurisdiction of the California Department of Corrections (in state prison or on parole) and I am not I am ( ) I know of no required to register as a sex offender under dates which would be inconvenient. Penal Code section 290. ( ) I request that the argument of this appeal not be calendared for the following dates, which are inconvenient. I have Date: included religious holidays.
(TYPE OR PRINT NAME OF PERSON WHOSE NAME IS TO BE CHANGED)
(If petitioner is Date:
COUNSEL OR PRO SE LITIGANT MUST ADVISE THE COURT IN WRITING OF ANY CHANGEISIN AVAILABILITY. FAILURE (SIGNATURE OF PERSON WHOSE NAME TO BE CHANGED) TO DO SO MAY BE CONSIDERED BY THE COURT IN DECIDING MOTIONS FOR ADJOURNMENT BASED ON represented by an attorney, the attorney's signature follows): UNAVAILABILITY. RELATED CASES ( ) This case has not been before this Court previously. (SIGNATURE and citation has been before this Court previously. The short title, docket number OF ATTORNEY)are:
(TYPE(OR ) PRINT NAME) This case
(Each petitioner must sign this petition in the space provided below or, if additional pages are attached, at the end of the last ( penalty of perjury to this appeal or involving the same issue havethat the information inbefore this Court. The short attachment.) I declare under ) Matters related under the laws of the State of California been or presently are the foregoing petition is true and correct. titles, docket numbers and citations are: Date:
Signature of counsel of record or pro se litigant:
(TYPE OR PRINT NAME)
Signature of counsel who will argue the appeal, if different:
(SIGNATURE OF PETITIONER)
Date:
Type or Print Name Name of Firm: Address:
(TYPE OR PRINT NAME) ADD ADDITIONAL SIGNATURE LINES FOR ADDITIONAL PETITIONERS
Type or Print Name
(SIGNATURE OF PETITIONER)
Telephone:
Date:
SIGNATURE OF PETITIONERS FOLLOWS LAST ATTACHMENT
Telephone:
Date:
Form Adopted for Mandatory Use Judicial Council of California NC-110 [Rev. January 1, 2003]
July 2000
ATTACHMENT TO PETITION FOR CHANGE OF NAME
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Code of Civil Procedure, § 1275 et seq.
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