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Washoe County Name Change Petition Form

This petition is for the use of Nevada residents who seek to apply for a legal name change.

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Extracted 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 
1	
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 
2	
 
    
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________ 
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 
3	
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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   1	
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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   1	
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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   1	
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
Next: Wyoming Living Will Form Previous: West Virginia Name Change Petition Form
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