Fillable Amend Birth Certificate Adult (Clerk of the Superior Court)

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Amend Birth Certificate Adult (Clerk of the Superior Court)

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Revised 01.07.19
AMEND/CORRECT
BIRTH CERTIFICATE
PINAL COUNTY
FOR AN ADULT
INSTRUCTIONS AND FORMS
Provided as a Public Service by
AMANDA STANFORD
Clerk of the Superior Court
Reset Form
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CV_ABCA_COSCPinal_08.16.18
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PETITION FOR COURT ORDER TO AMEND (CORRECT)
A BIRTH CERTIFICATE
This packet contains court forms and instructions to file (fill in reason for forms and
instructions). Items in BOLD are forms that you will need to file with the Court. Non-bold items
are instructions or procedures. Do not copy or file those pages!
Order
Title
# of Pages
1
Table of Contents (this page)
1
2
Check List
1
3
Procedures: What to do After You Have Completed All Forms
3
4
Civil Cover Sheet
2
5
Petition for Court Order to Amend Birth Certificate
5
6
Court Order to Amend Birth Certificate
2
7
Notice of Hearing
1
The documents you have received are copyrighted by the Superior Court of Arizona in Pinal County.
You have permission to use them for any lawful purpose. These forms shall not be used to engage in
the unauthorized practice of law. The Court assumes no responsibility and accepts no liability for
actions taken by users of these documents, including reliance on their contents. The documents are
under continual revision and are current only for the day they were received. It is strongly
recommended that you verify on a regular basis that you have the most current documents.
Page 1 of 1
CV_ABCA_COSCPinal_07.30.18
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DO_ABCA_COSCPinal_01.07.19
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PROCEDURES
HOW TO FILE FOR A COURT ORDER FOR
CORRECTION OF A BIRTH CERTIFICATE FOR AN ADULT
STEP 1: FILL OUT THE FORMS: Use Black Ink Only. Keep Forms Neat &
Clean. Do Not Fold Forms. Do Not Use Line Paper When Including
Attachments.
Fill out the following forms:
• “Petition for Court Order to Amend a Birth Certificate for an Adult”
• “Civil Cover Sheet” (Write in your name as “Plaintiff”)
• “Notice of Hearing”
STEP 2: MAKE COPIES:
Make 1 copy of the “Petition for Court Order to Amend a Birth Certificate
for an Adult.”
STEP 3: FILE THE PAPERS AT THE COURT:
WHO: Who can file the “Petition to Amend Birth Certificate of an Adult”?
The adult who seeks the change, or his or her attorney or guardian.
GO TO: GO TO THE CLERK OF COURT TO FILE YOUR
PAPERS: You should go to the Court at least two hours before it closes. For
locations and times of operation please visit our website at:
www.coscpinalcountyaz.gov/office.html
Contact Information for all offices:
Toll Free: 888.431.1311 • Local: 520.509.3555 or 311 • Fax: 520.866.5320
FEES: A list of current fees is available on our website at:
www.coscpinalcountyaz.gov/fees.html
If you cannot afford the filing fee and/or the fee for having the papers served
by the Sheriff or by publication, you may request a deferral (payment plan)
when you file your papers with the Clerk of the Court. Deferral Applications
are available at no charge.
PAPERS: Hand two (2) sets of your court papers to the Clerk along with the
filing fee. Make sure the filing clerk conforms (stamps) all your copies
and returns them to you.
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STEP 4:
STEP 5:
NOTICE OF HEARING:
After filing the application, the Clerk of Court’s office will mail you the
“Notice of Hearing” once a hearing date has been scheduled by the court.
ATTEND THE HEARING
Any adult requesting a change to his or her own birth certificate MUST be
present at the hearing.
BRING THESE DOCUMENTS TO YOUR HEARING:
•
2 copies of
“Order Amending Birth Certificate for an Adult”
for
the Judge to sign. One copy will go in the Court file and the other will
be conformed and returned to you.
•
There is a court fee for each certified copy. *
•
Photo identification.
•
Copy of your Arizona Birth Certificate
•
A Clerk stamped copy of all filed documents
•
Prior Name Change orders (If applicable)
•
Copy of Orders of Protection and/or Injunctions Against Harassment
still in effect (If applicable)
Always make a copy of any document you submit to the Court and keep a copy for your
records.
If you want a new, corrected birth certificate, you may purchase one for a fee after you present
a CERTIFIED COPY of the Court Order to:
The State of Arizona’s Office of Vital Records
TO GET A CERTIFIED COPY OF YOUR COURT ORDER:
➢
You may purchase a certified copy at any of our Clerk office locations:
All adults seeking a change to their birth records should bring with them their passport, driver's license,
or other government-issued photo identification.
•
Adults
seeking
to change their birth records MUST bring a copy of their government-issued birth
certificate.
• The Court will not change a birth certificate without first seeing a copy.
• Hospital-issued birth certificates are largely ceremonial and generally will not satisfy Court
requirements; the Court is looking for government-issued birth certificates.
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www.coscpinalcountyaz.gov/office.html
➢
If you need additional copies after that time, you will need to go to the Request
Court Records page at: www.coscpinalcountyaz.gov/request-records.html
➢
A list of current fees is available on our website at:
www.coscpinalcountyaz.gov/fees.html
September 26, 2018 Page 1 CV10F-010119
In the Superior Court of the State of Arizona
In and For the County of _______________
Case Number _____________________________
CIVIL COVER SHEET- NEW FILING ONLY
(Please Type or Print)
Plaintiff’s Attorney __________________________
Attorney Bar Number ________________________
Plaintiff’s Name(s): (List all) Plaintiff’s Address:
______________________________________ _____________________________________________
_____________________________________________
_____________________________________________
______________________________________
______________________________________
(List additional plaintiffs on page two and/or attach a separate sheet).
Defendant’s Name(s): (List All) ______________________________________________________________________
_________________________________________________________________________________________________
(List additional defendants on page two and/or attach a separate sheet)
RULE 26.2 DISCOVERY TIER OR MONETARY RELIEF CLAIMED:
IMPORTANT: Any case category that has an asterisk (*) MUST have a dollar amount claimed or Tier
selected. State the monetary amount in controversy or place an “X” next to the discovery tier to which the
pleadings allege the case would belong under Rule 26.2.
Amount Claimed $_______________ Tier 1 Tier 2 Tier 3
NATURE OF ACTION
Place an “X” next to the one case category that most accurately describes your primary case. Any case category
that has an asterisk (*) MUST have a dollar amount claimed or Tier selected as indicated above.
TORT MOTOR VEHICLE:
Non-Death/Personal Injury*
Property Damage*
Wrongful Death*
TORT NON-MOTOR VEHICLE:
Negligence*
Product Liability – Asbestos*
Product Liability – Tobacco*
Product Liability – Toxic/Other*
Intentional Tort*
Property Damage*
Legal Malpractice*
Malpractice – Other professional*
Premises Liability*
Slander/Libel/Defamation*
Other (Specify) _______________*
MEDICAL MALPRACTICE:
Physician M.D.* Hospital*
Physician D.O.* Other*
CONTRACTS:
Account (Open or Stated)*
Promissory Note*
Foreclosure*
September 26, 2018 Page 2 CV10F-010119
Buyer-Plaintiff*
Fraud*
Other Contract (e.g., Breach of Contract)*
Excess Proceeds – Sale*
Construction Defects (Residential/Commercial)*
Six to Nineteen Structures*
Twenty or More Structures*
Credit Card Debt (Maricopa County Filings Only)*
OTHER CIVIL CASE TYPES:
Eminent Domain/Condemnation*
Eviction Actions (Forcible and Special Detainers)*
Change of Name
Transcript of Judgment
Foreign Judgment
Quiet Title*
Forfeiture*
Election Challenge
NCC – Employer Sanction Action (A.R.S. §23-212)
Injunction against Workplace Harassment Injunction
against Harassment
Civil Penalty
Water Rights (Not General Stream Adjudication)*
Real Property*
Special Action against Lower Courts
(See lower court appeal cover sheet in Maricopa)
Immigration Enforcement Challenge (A.R.S. §§1-
501, 1-502, 11-1051)
UNCLASSIFIED CIVIL:
Administrative Review
(See lower court appeal cover sheet in Maricopa)
Tax Appeal
(All other tax matters must be filed in the AZ Tax
Court)
Declaratory Judgment
Habeas Corpus
Landlord Tenant Dispute – Other*
Declaration of Factual Innocence (A.R.S. §12-771)
Declaration of Factual Improper Party Status
Vulnerable Adult (A.R.S. §46-451)*
Tribal Judgment
Structured Settlement (A.R.S. §12-2901)
Attorney Conservatorships (State Bar)
Unauthorized Practice of Law (State Bar)
Out-of-State Deposition for Foreign Jurisdiction
Secure Attendance of Prisoner
Assurance of Discontinuance
In-State Deposition for Foreign Jurisdiction
Eminent Domain – Light Rail Only*
Interpleader – Automobile Only*
Delayed Birth Certificate (A.R.S. §36-333.03)
Employment Dispute – Discrimination*
Employment Dispute – Other*
Verified Rule 45.2 Petition
Other (Specify)*____________________________
EMERGENCY ORDER SOUGHT:
Temporary Restraining Order Provisional Remedy OSC Election Challenge
Employer Sanction Other (Specify) ________________________
COMMERCIAL COURT (Maricopa County Only)
This case is eligible for the commercial court under Rule 8.1, and plaintiff requests assignment of this case to the
commercial court. More information on the commercial court, including the most recent forms, are available on the court’s
website at https://www.superiorcourt.maricopa.gov/commercial-court/.
Additional Plaintiff(s)
__________________________________________________________________________________________
__________________________________________________________________________________________
Additional Defendant(s)
__________________________________________________________________________________________
__________________________________________________________________________________________
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CV_PABCA_COSCPinal_08.16.18
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Person Filing:
Address (if not protected):
City, State, Zip Code:
Telephone:
Email Address:
Lawyer’s Bar Number:
Representing Self, without a Lawyer or Attorney for Petitioner OR
Respondent
SUPERIOR COURT OF
ARIZONA IN PINAL COUNTY
In the Matter of:
Case Number: S1100CV_______________
PETITION FOR COURT ORDER TO
AMEND BIRTH CERTIFICATE
of an ADULT (A.R.S. § 36-337)
Name of Adult
whose birth record needs correction
UNDER PENALTY OF PERJURY
1.
INFORMATION ABOUT THE ADULT whose birth record needs correction:
FULL NAME:
(First) (Middle) (Last)
Current Legal Name (if different from above):
(First) (Middle) (Last)
Address is as listed at top left
Above or
if not
, my address is:
For Clerk’s Use Only
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A CERTIFIED COPY OF MY CURRENT ARIZONA BIRTH CERTIFICATE IS
ATTACHED.
2.
INFORMATION ON THE BIRTH RECORD
A.
☐ The birth record contains INCORRECT information about the above-
named adult:
MY NAME
appears
wrongly
as ________________________________
DATE OF BIRTH
appears
wrongly
as ________________________________
PLACE OF BIRTH
appears
wrongly
as ________________________________
Other Information
appears
wrongly
as ________________________________
Following is the CORRECT information about the above-named adult: I ask that
the birth record be ordered changed as indicated below:
MY NAME
should appear as __________________________________
DATE OF BIRTH
should appear as __________________________________
PLACE OF BIRTH
should appear as __________________________________
Other Information
should appear as __________________________________
Case Number: ________________
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B. ☐ The birth record contains INCORRECT information about
the
FATHER
.
FATHER’S NAME*
appears
wrongly
as ________________________________
DATE OF BIRTH
appears
wrongly
as ________________________________
PLACE OF BIRTH
appears
wrongly
as _________________________________
RACE
appears
wrongly
as ________________________________
Following is the CORRECT information about the FATHER.
I ask that the birth records be ordered changed as indicated below:
FATHER’S NAME*
should appear as
DATE OF BIRTH
should appear as
PLACE OF BIRTH
should appear as
RACE
should appear as
* to correct error in name of the father – not to change identity / paternity.
C. ☐ The birth record contains INCORRECT information about
the
MOTHER
.
MOTHER’S NAME*
appears
wrongly
as ________________________________
DATE OF BIRTH
appears
wrongly
as ________________________________
Case Number: ________________
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PLACE OF BIRTH
appears
wrongly
as _____________________________
RACE
appears
wrongly
as ____________________________
MARITAL STATUS
appears
wrongly
as ______________________________
RESIDENTIAL ADDRESS
appears
wrongly
as ______________________________
Following is the CORRECT information about the MOTHER.
I ask that the birth records be ordered changed as indicated below:
MOTHER’S NAME*
should appear as ________________________________
DATE OF BIRTH
should appear as ______________________________
PLACE OF BIRTH
should appear as _____________________________
RACE
should appear as
MARITAL STATUS
should appear as
RESIDENTIAL ADDRESS
should appear as
* to correct error in name of the mother – not to change identity / maternity.
REQUEST TO THE COURT:
I request the Arizona Office of Vital Records be ordered to remove and replace the
incorrect information on the subject birth record with the correct information as indicated
above.
Case Number: ________________
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OATH OR AFFIRMATION OF APPLICANT
I affirm under penalty of perjury the information provided on this document is true and
correct.
Date:
Petitioner’s Signature
Printed Name of Petitioner
STATE OF
COUNTY OF
Subscribed and sworn to or affirmed before me this: by
(date)
.
(notary seal) Deputy Clerk or Notary Public
Case Number: ________________
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CV_OABCA_COSCPinal_08.16.18
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SUPERIOR COURT OF ARIZONA
IN Pinal COUNTY
In the Matter of:
Case Number: S1100CV
Petitioner (Legal Name Currently Used)
ORDER AMENDING BIRTH
CERTIFICATE OF AN ADULT
A.R.S. § 36-337
THE COURT FINDS:
1.
This case has come before this Court to amend the birth certificate of the Petitioner.
2.
Pursuant to A.R.S. §36-337, this Court has jurisdiction to order that the Petitioner’s birth
certificate be amended to correct errors or omissions contained in the original birth certificate.
3.
Good cause exists to grant the Petition to amend the birth certificate as requested by the
Petitioner.
4.
The Petitioner’s Name, Date and Place of Birth appears on his or her Arizona birth
certificate as follows:
THE PRESENT NAME APPEARING ON THE SUBJECT BIRTH
CERTIFICATE:
First Middle Last
Date of Birth:
Month Day Year
Place of Birth:
City State Nation
For Clerk’s Use Only
Page 2 of 2
CV_OABCA_COSCPinal_08.16.18
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THE Court Orders:
☐ 1. The Name appearing on the birth certificate is changed to:
First Middle Last
☐ 2. That the birth certificate records of the petitioner be changed to correct the following
errors or omissions:
That the birth certificate records of the Petitioner should be changed to correct the
following errors or omissions - (continued)
3.
For a person born in the State of Arizona, the Office of Vital Records is ordered
to amend the birth record to reflect the new name or other corrected
information as ordered above.
4.
This Order does not release the Applicant from any obligations incurred or
harm any rights of property or action in any previous name.
5.
Other orders:
DONE IN OPEN COURT:
Date
Judicial Officer
Case Number: ________________
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CV_NOH_COSCPinal_07.30.18
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IN THE SUPERIOR COURT OF ARIZONA
PINAL COUNTY
In the matter of: ) Case No: S1100CV
)
)
)
) Notice of Hearing
)
)
)
)
)
Name of Adult
whose birth record needs correction.
A Hearing, in the above entitled action, has been set for:
Date: at a.m./p.m.
Place: Pinal County Justice Complex
971 Jason Lopez Circle, Building A
Florence, AZ
Before: Hon.
AMANDA STANFORD
Clerk of the Superior Court
By
Deputy Clerk
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Amend Birth Certificate Adult (Clerk of the Superior Court)

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Completed 25 July 2020

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