Washoe County Name Change Petition Form
This petition is for the use of Nevada residents who seek to apply for a legal name change.
DownloadExtracted Text for Proper Search
Nevada AOC – Planning and Analysis Division Form PA 201
2JDC - Revised 03/12/2010 Rev. 2.4E
CIVIL COVER SHEET
Washoe County, Nevada
Case No. ____________________________________
(Assigned by Clerk’s Office)
I. Party Information
Plaintiff(s)/Petitioner (name/address/phone):
DOB:
____________________________
Attorney (name/address/phone):
II. Nature of Controversy (Please check applicable bold category and Arbitration Requested
applicable subcategory, if appropriate)
Civil Cases
Real Property Torts
Landlord/Tenant - LT
Unlawful Detainer - UD
Title to Propert y
Foreclosure - FC
Liens - LE
Quiet Title - QT
Specific Performance - SP
Condemnation/Eminent Domain-CD
Other Real Property - RO
Partition - PT
Planning/Zoning - PZ Negligence
Negligence – Auto - VP
Negligence – Medical/Dental
- MD
Negligence – Premises Liability -SF
(Slip/Fall)
Negligence – Other - NO
Product Liability
Product Liability/Motor Vehicle-VH
Other Torts/Product Liability - PL
Intentional Misconduct
Torts/Defamation(Libel/Slander)-DF
Interfere with Contract Rights - IR
Employment Torts (Wrongful Term)-WT
Other Torts - TO
Anti-trust - AI
Fraud/Misrepresentation - FM
Insurance- IN
Legal Tort- LG
Unfair Competition - UC
Probate Other Civil Filing Types
Summary Administration - SU
General Administration - FA
Special Administration - SL
Set Aside Estates - SE
Trust/Conservatorships
Individual Trustee - TR
Corporate Trustee - TM
Other Probate - OP
Construction Defect - CF
Chapter 40
General
Breach of Contract
Building & Construction - BC
Insurance Carrier - BF
Commercial Instrument - CI
Other Contracts/Acct/Judg. - CO
Collection of Actions - CT
Employment Contract - EC
Guarantee - GU
Sale Contract - SC
Uniform Commercial Code - UN
Civil Petition for Judicial Review
Foreclosure Mediation - FO
Other Administrative Law - AO
Department of Motor Vehicles-DM
Worker’s Compensation Appeal-SI
Appeal from Lower Court
Transfer from Justice Court - TJ
Justice Court Civil Appeal - CA
Civil Writ
Other Special Proceeding - SS
Other Civil Filing
Compromise of Minor’s Claim - CM
Conversion of Property - CN
Damage to Property - DG
Employment Security - ES
Enforcement of Judgment - EJ
Foreign Judgment – Civil – FJ
Other Personal Property - PO
.
Recovery of Property - RE
Stockholder Suit - ST
Other Civil Matters – GC
Confession of Judgment - CJ
Name Change – Adult - NC
Out of State Commission - OS
Petition to Seal Criminal Records-PS
III. Business Court Requested (If you check a box below, you must check an additional box above to determine case type.)
NRS Chapters 78-88 Investments (NRS 104 Art. 8) Enhanced Case Mgmt/Business
Commodities (NRS 90) Deceptive Trade Practices (NRS 598) Other Business Court Matters
Securities (NRS 90) Trademarks (NRS 600A)
Date
Signature of initiating party or representative
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REVISED 7/2010 AA N-1 PETITION
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Code $3490
Name_____________________________
Address___________________________
____________________________
Telephone Number___________________
Acting In Proper Person
IN THE SECOND JUDICIAL DISTRICT COURT OF THE STATE OF NEVADA
IN AND FOR THE COUNTY OF WASHOE
In the Matter of the Petition Of:
________________________________, Case No._____________________
(Your present name)
Dept. No._____________________
For a change of name.
________________________________/
UPETITION FOR LEGAL CHANGE OF NAME
____________________________________________________, acting in proper person,
(Your present name)
petitions this Court as follows:
I.
Petitioner,__________________________________, was born in __________________,
(Your present name) (City)
______________________, on _________________________to _________________________
(State) (Date of birth) (Father’s name)
__________________ and _________________________________, who __________________
(Mother’s name) (Were or were not)
husband and wife.
II.
I wish to change my name from______________________________________________
to__________________________________________________ because:
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REVISED 7/2010 AA N-1 PETITION
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_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
III.
I have _______________ been convicted of a felony.
(Have or have not)
If I have been convicted of a felony, each offense, the date of conviction, the County and
State of conviction, and the final result are as follows:
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
I am not seeking a name change for any illegal purpose.
State reason for wanting name change
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REVISED 7/2010 AA N-1 PETITION
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IV.
I currently reside at:
___________________________
(Address)
____________________________
____________________________
____________________________
(Telephone number)
and I have lived there since ________________________ and have been a resident of Nevada
(When you moved to present address)
for ______________________________. My previous address was:______________________
(Length of time you have lived in Nevada) (Your previous address)
______________________________________, and I resided there for ____________________.
(County, State, Zip Code) (How long you lived there)
V.
I am requesting that my name be legally changed to:
____________________________________________________________________________
(Clearly print your full new name as it will appear on all your legal documents)
VI.
0 BI (do or do not) _____________wish to have a new birth certificate issued showing my new
name as my original name.
This document does not contain the Social Security number of any person.
I declare, under penalty of perjury under the law of the State of Nevada, that the
foregoing is true and correct.
DATE:______________________________
_____________________________
(Print name)
_____________________________
(Signature)
REVISED 7/2010 AA N-1 NOTICE 1
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28 Code:
2610
Name:_______________________________
Address: _____________________________
______________________________
Telephone Number: ____________________
Appearing in Proper Person
IN THE SECOND JUDICIAL DISTRICT COURT OF THE STATE OF NEVADA
IN AND FOR THE COUNTY OF WASHOE
In the Matter of the Petition of
___________________________________,
(Your Current Name) Case No. _______________________
Dept. No. ______________________
For a Change of Name.
___________________________________/
NOTICE
On the ______ day of ___________________, 20______, a Petition was filed\
in the
above-entitled Court by _______________________________________, re questing that the Court
(Print your current name here.)
legally change her/his present name of ___________________________________________ to
(Print your current name here.)
__________________________________________.
(Print your new name here.)
Any opposition to this Petition s hould be filed with the above-entitled Court within ten (10)
days of the final publication of this Notice.
This document does not contain the So cial Security number of any person.
DATED this _______ day of __________________________, 20______.
HOWARD W. CONYERS
CLERK OF THE COURT
By: _________________________________________
Deputy Clerk
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Code: 3715
Name________________________________
Address______________________________ ______________________________
Telephone No.________________________
Acting in Proper Person
IN THE SECOND JUDICIAL DISTRICT COURT OF THE STATE OF NEVADA
IN AND FOR THE COUNTY OF WASHOE
In The Matter of the Petition Of
________________________________ Ca se No._________________
For change of Name. Dept. No.________________
___________________________________/
PROOF OF PUBLICATION
Attached is the proof of publication of the Notice.
This document does not contain the Social Security number of any person.
I declare, under penalty of perjury under the law of the State of Nevada\
, that the
foregoing is true and correct.
DATED this _____day of _________________, ______.
________________________________
(Signature)
________________________________
(Address)
________________________________
________________________________
(Telephone number)
INDEX OF EXHIBITS
Exhibit Number
Number of Pages ______
Exhibit Description ____________________________________________________\
________
Exhibit Number ______ Number of Pages ______
Exhibit Description ____________________________________________________\
________
Exhibit Number ______ Number of Pages ______
Exhibit Description ____________________________________________________\
________
Exhibit _____
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Code: 3860
Name________________________________
Address______________________________ ______________________________
Telephone No.________________________
Acting in Proper Person
IN THE SECOND JUDICIAL DISTRICT COURT OF THE STATE OF NEVADA
IN AND FOR THE COUNTY OF WASHOE
In The Matterof the Petition of:
_______________________________ Case No. ________________ (Your name) Dept. No. __________________
For Change of Name.
______________________________________/
REQUEST FOR SUBMISSION
It is hereby requested that th e Petition for Name Change and all other documents filed herein
be submitted to the Court for decision.
This document does not contain the Social Security number of any person.
I declare, under penalty of perjury under the law of the State of Nevada\
, that the
foregoing is true and correct.
Date:__________________________________
_____________________________________ (Print name)
_____________________________________ (Signature)
____________________________________ (Address)
____________________________________
____________________________________
(Telephone number)
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Code: 2792
IN THE SECOND JUDICIAL DISTRICT COURT OF THE STATE OF NEVADA
IN AND FOR THE COUNTY OF WASHOE
In the Matter of the Application of:
_________________________________ Case N o.________________________
(Your name)
Dept. N o. ______________________
For a change of Name.
_________________________________________/
ORDER CHANGING NAME
This Court, having revi ewed the Petition of _______________________________________
(Your present name)
to change ________________ name, proof of Publication having been filed and the statutory time
(His or Her)
to oppose having run and no opposition having been filed to the Petition\
,
IT IS HEREBY ORDERED that the name of __________________________________
be and hereby is, legally changed from__________________________________\
___________
to ____________________________________________________________.
IT IS HEREBY FURTHER ORDERED that a new birth certificate ___________issue
(shall or shall not)
indicating Petitioner’s new name as Petitioner’s original birth name.
Dated: ______________________________________
___________________________________
DISTRICT JUDGE
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