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King County Washington Minor Name Change Petition Form

In King County of the State of Washington, a minor who seeks a legal name change is required to use this specific application form.Download

Extracted Text for Proper Search

Revised 7/2010 1 
   
 
 
KING COUNTY DISTRICT COURT  
STATE OF WASHINGTON  
 
 
In re the Petition of:  
________________________________  )    No. _________________________ 
                ) 
for the Change of Name of:                    ) 
                )    PETITION FOR CHANGE OF NAME    
________________________________  )    OF A MINOR 
A Minor.   [First, Middle Last Name]  ) 
 
Comes now ________________________________________ (legibly print full name)  and 
                                            First, Middle, Last 
 ________________________________________________(legibly print full name) petitioning  
     	
First, Middle, Last  	
 the court for an order changing the name of    _________________________________________  
               	
First, Middle, Last  	
(legibly print current name) his, her, their (circle one)    son, daughter, ward (circle one),  to the 
name ________________________________________________________ , and states that: 
        First, Middle, Last 
  1. The child is __ years of age and was born on _____________, at _________________. 
   (date of birth) (place of birth) 	
2. Is the child a resident of King County, Washington?  Yes 	  No 	 	
3.  Is the child required to register as a sex offender ?  Yes 	  No 	 	
[Failure to provide required notice to the Kin g County Sheriff and Washington 
State Patrol is a crime.  RCW 9A.44.130(8).] 
4.  Is the child an offender under the jurisdiction of the Department of Corrections? 
Yes 	  No 	 	
      [Failure to provide required notice to the DOC is a crime.  RCW 4.24.130.]   
5. Is/are t he petitioner(s) the parent(s) of the child ?  Yes 	 No 	 	
6.  If not the parent(s), is /are the petitioner (s) the child’s legal guardian and ha ve the legal 
authority to submit this petition.  Yes 	
 No 	 	
7.  The child’s other parent : 	
A.  Has given  consent to this name change and signed the petition. Yes	 No 	 	
B.  Has not given consent to this name change.  Yes 	  No 	 	
C.   Has not been located and has had no contact with petitioner.  Yes 	  No 	 	
 Date of last contact with other parent:  ____________________________________

Revised 7/2010 2 
 	
8.  Has the child ever had a name change prior to this petition?  Yes 	  No 	 	
Please explain.  (Date, place, reason) _________________________________________ 
_______________________________________________________________________ 
9.  I/we declare this petition is not made for any illegal or fraudulent purpose. 
10.  I/we declare this petition will not be detrimental to the interests of anyone else.  
11.  Any child named in this petition who is age 14 or older joins in the petition and has 
signed the petition.  
12.  Petitioner(s) request a change of name for the following reason(s).  Please explain.  
____________________________________________________________________ 
____________________________________________________________________ 
 
   
 
  I DECLARE UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE 
STATE OF WASHINGTON THAT THE FOREGOING STATEMENTS IN THIS 
PEITION FOR A NAME CHANGE OF A MINOR ARE TRUE AND CORRECT.  
 
Signed at ____________________________, Washington, on ____________________, 20___. 
      City              Date 
 
____________________________________      ___________________________________  Parent/Guardian  Signature        Parent/Guardian Signature 
 
____________________________________           ____________________________________  Parent/Guardian  Printed Name      Parent/Guardian Printed Name 
 
 
____________________________________  ____________________________________ 
Minor’s Signature (if over 14 years of age)                                  Minor’s Printed Name 
 
 
                       Received: ___________________________ 
                  Court Clerk
Next: Kentucky Name Change Petition Form Previous: Kansas Medical Power of Attorney Form
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