Fillable Filing Fee: The filing fee is $270. About (Family Law Self Help Center)

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Filing Fee: The filing fee is $270. About (Family Law Self Help Center)

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Many family law matters involve complex and valuable legal rights which cannot adequately be protected without the assistance
of an attorney. The information provided is basic, general information that does not fit all situations. It is the duty of each self-
represented individual to know what rules of court and law apply. For more information on the law, these forms, and free classes,
visit www.familylawselfhelpcenter.org or the Family Law Self Help Center at 601 N. Pecos Road.
Filing Fee: The filing fee is $270.
About This Packet: This packet is for an adult whose parents’ names appear incorrect on their
birth certificate due to clerical error(s) (a misspelling, last names that are not in the right
order, etc.) which they would like to have corrected. These forms will also allow you to
change your name, if desired. These forms do not allow you to change a parent’s name to
someone else’s name.
Use black ink and write clearly.
Family Court Cover Sheet
This form provides basic information about you so the Clerk can open your case. You are
the “petitioner.”
Petition to Correct Birth Certificate
This form tells the Court what is wrong on your birth certificate. If a parent’s name is
wrong, clearly write in section 3 the incorrect name as it appears on the birth certificate
and the correct name that should appear. If there is something other than a parent’s name
or your name that needs to be corrected clearly write in section 3 the incorrect information
as it appears on the birth certificate and the correct information that should appear.
NOTE: You can request a name change. A name change must be requested even if the
correction to the birth certificate is only to change a typo or clerical error in your name. If
a name change is requested section 4 must be completed. Do not ask for a name change
unless you want to be known by the new name going forward.
Copy of Birth Certificate
Attach a copy of your birth certificate to this form.
Notice of Petition for Change of Name
If you want to change your legal name, you must fill out this form. It will have to be
published in a newspaper in Clark County one time.
Request for Summary Disposition & Declaration in Support
This form asks the judge to grant the correction without you having to appear at a hearing.
Order for Correction of Birth Certificate
The judge signs this if the correction is approved. Complete everything on the form
except for the date and the judge’s signature.
In person: Bring the documents listed above to the Family Courthouse. You will file everything
except the Order with the Clerk of Court. All documents are electronically filed and will
be emailed to you after processing. You must provide a valid email address when filing.
Online: You can upload your documents at https://nevada.tylerhost.net/OfsWeb/. There is a
$3.50 fee to e-file your documents. The Order will not be filed until later after the judge
has signed it.
*skip this step if you do not want a name change*
Contact a Newspaper: The Notice of Petition for Change of Name must be published one time in a
Clark County newspaper. People often use the Nevada Legal News (702-382-2747) or the
Review-Journal (702-383-0320). Contact a newspaper to arrange for publication.
File the Affidavit of Publication: After publication is complete, the newspaper should prepare an
“Affidavit of Publication.” This is the proof that the Notice of Petition was published. The
newspaper usually sends this to the court for filing after publication is complete. If they do
not, contact the newspaper to obtain the affidavit so you can file it yourself.
NOTE: The judge cannot sign the final order until 10 days after publication is finished. Do
not submit the final order until 10 days after the date of publication listed on the Affidavit of
Publication.
• When you file your documents, you will find out which judge is assigned to your case.
• Take the Order and a copy of all the documents you filed to the department drop box on
the 1
st
floor at family court (or mail it to the court).
• If the correction is approved, the judge will sign the order. The judge’s staff will send
you a copy of the final order in the mail, or will contact you to pick up and file the order
at the court.
NOTE: The judge may require a hearing if something about your request is not clear. If
so, the judge’s staff will instruct you to set a hearing. See the Self-Help Center to get an
“uncontested setting slip” that you can use to set a court date.
Get a Certified Copy: The Office of Vital Statistics requires a certified copy of the Order to
Correct Birth Certificate before they will change the birth certificate. You can get a
certified copy at the courthouse for $3. Ask to see the “Records” department to get a
certified copy.
Contact Vital Statistics: Contact the Office of Vital Statistics to have the birth certificate
corrected. You can reach Nevada’s Office of Vital Statistics
at http://dpbh.nv.gov/Programs/BirthDeath/Birth_and_Death_Vital_Records_-_Home/ or by
calling (775) 684-4242.
EIGHTH JUDICIAL DISTRICT COURT
CLARK COUNTY, NEVADA
FAMILY COURT COVER SHEET
CASE NO. (To be assigned by the Clerk’s Office)
Do you or any other party in this case (including any minor child) have any other current case(s) or past
case(s) in the Family Court or Juvenile Court in Clark County?
YES NO
If yes, complete the other side of this form
PARTY INFORMATION (Please Print)
Plaintiff/Petitioner Defendant/Respondent/Co-Petitioner/Ward/Decedent
Last Name: Last Name:
First Name: Middle Name: First Name: Middle Name:
Home Address: Home Address:
City, State, Zip: City, State, Zip:
Mailing Address: Mailing Address:
City, State, Zip: City, State, Zip:
Phone #: Date of Birth: Phone #: Date of Birth:
Attorney Information Attorney Information
Name: Bar No. Name: Bar No:
Address: Address:
City, State, Zip: City, State, Zip:
Phone #: Phone #:
(Check one box only for the type of case being filed with this cover sheet)
DOMESTIC
OTHER DOMESTIC RELATIONS
PETITIONS
GUARDIANSHIP PROBATE
Marriage Dissolution
Annulment
Divorce –No minor child(ren)
Divorce –With minor child(ren)
Foreign Decree
Joint Petition –No minor child(ren)
Joint Petition – With minor child(ren)
Separate Maintenance
Adoption –Minor
Adoption –Adult
Child Custody (Non-Divorce)
Mental Health
Name Change
Paternity
Permission to Marry
Support - Other
Temporary Protective Order (TPO)
Termination of Parental Rights
Visitation (Non-Divorce)
Other (identify) __________________
Guardianship of an Adult
Person
Estate
Person and Estate
Guardianship of a Minor
Person
Estate
Person and Estate
Guardianship Trust
Summary Administration
General Administration
Special Administration
Set Aside Estates
Trust/Conservatorships
Individual Trustee
Corporate Trustee
Other Probate
MISC. JUVENILE PETITIONS IV-D CHILD SUPPORT PETITIONS
Work Permit Emancipation DA – UIFSA Child Support In State IV-D
List children involved in this case (If more than 3 children, please enter the information on the reverse side)
Last Name First Name Middle Name Date of Birth Relationship
1.
2.
3.
_________________________________ __________________________________ ________________
Printed Name of Preparer Signature of Preparer Date
Revised 07/01/12
Eighth Judicial District Court
Pursuant to NRS 3.275
/s/
© 2019 Family Law Self-Help Center Petition to Correct Birth Certificate (Adult)
* You are responsible for knowing the law about your case. For more information on the law, this form, and free
classes, visit www.familylawselfhelpcenter.org or the Family Law Self Help Center at 601 N. Pecos Road. To find
an attorney, call the State Bar of Nevada at (702) 382-0504.
1
PBC
Your Name: _________________________
Address: ____________________________
City, State, Zip: ______________________
Phone: _____________________________
Email: ______________________________
Self-Represented Petitioner
DISTRICT COURT
CLARK COUNTY, NEVADA
In the Matter of the Application of:
___________________________________
(your name)
For the Correction of Birth Certificate and
Issuance of New Birth Certificate.
CASE NO.: ____________________
DEPT.: _____________________
PETITION TO CORRECT BIRTH CERTIFICATE (ADULT)
Petitioner (your name) ____________________________ respectfully states as follows:
1. Petitioner was born on (date of birth) ___________________________________ in
(city) ____________________, (state) ___________________________.
2. Petitioner has resided in Clark County, Nevada since (date) ____________________ and
intends to live in Clark County, Nevada indefinitely.
3. Request for Correction. At the time of Petitioner’s birth, the following information on
Petitioner’s birth certificate was incorrectly entered and needs to be corrected:
(☒ check all that apply)
Page 2 of 5 - Petition to Correct Birth Certificate (Adult)
Mother’s Information is Incorrect. The mother’s name on the birth certificate is
incorrect. The birth certificate erroneously lists the mother’s name as (write the
mother’s name with the mistakes as it appears on the birth certificate):
Incorrect: ___________________________________________________________
(First) (Middle) (Last)
The correct mother’s name should read:
Correct: ____________________________________________________________
(First) (Middle) (Last)
Father’s Information is Incorrect. The father’s name on the birth certificate is
incorrect. The birth certificate erroneously lists the father’s name as (write the
father’s name with the mistakes as it appears on the birth certificate):
Incorrect: ___________________________________________________________
(First) (Middle) (Last)
The correct father’s name should read:
Correct: ____________________________________________________________
(First) (Middle) (Last)
Other. The birth certificate incorrectly states that (explain what is incorrect on the
birth certificate and what changes need to be made):
Page 3 of 5 - Petition to Correct Birth Certificate (Adult)
4. Name Change. The Petitioner can request a name change. The Court may require you
to publish a notice of your name change in the newspaper one time. If approved, you
will be known by the new name in the future, and all of your ID will have to be changed.
No name change is requested (if no name change is requested, SKIP to item 5).
The Petitioner wishes to add a claim for relief under NRS 41.270 to change his/her
name because (explain the reason you want to change your name):
Petitioner is not requesting this name change to defraud creditors or for some other
fraudulent reason.
Has the Petitioner ever been convicted of a felony?
No, the Petitioner has never been convicted of a felony.
Yes, the Petitioner has been convicted of a felony. The details of my convictions are
(list all felony convictions, including the offense, date of conviction, and the county/state):
*If you have a felony conviction, you must provide a complete set of fingerprints
taken in the manner described by the Department of Public Safety at the time you
file this petition.
The name of the Petitioner should be changed from:
_____________________ ______________________ _______________________
(current first) (current middle) (current last)
who at the time of birth was given the name of
_____________________ ______________________ _______________________
(birthname first) (birthname middle) (birthname last)
to:
_____________________ ______________________ _______________________
(new first) (new middle) (new last)
Page 4 of 5 - Petition to Correct Birth Certificate (Adult)
5. Reason. Petitioner requests the above corrections because (explain):
A copy of the birth certificate will be filed separately under seal.
Petitioner prays for the following:
1. For an Order correcting the Petitioner’s birth certificate; and
2. For such other relief as the Court finds to be just and proper.
DATED _____________________________, 20____.
Submitted By: (your signature) _______________________________
(print your name
) _______________________________
/s/
Page 5 of 5 - Petition to Correct Birth Certificate (Adult)
VERIFICATION
Under penalties of perjury, I declare that I am the Petitioner in the above-entitled action;
that I have read the foregoing Petition and know the contents thereof; that the pleading is true of
my own knowledge, except for those matters therein contained stated upon information and
belief, and that as to those matters, I believe them to be true.
I declare under penalty of perjury under the law of the State of Nevada that the
foregoing is true and correct.
DATED _____________________________, 20____.
Submitted By: (your signature) _______________________________
(print your name
) _______________________________
/s/
ATTACH A COPY OF THE BIRTH CERTIFICATE TO THIS FORM
Your Name: _________________________
Address: ____________________________
City, State, Zip: ______________________
Phone: _____________________________
Email: ______________________________
Self-Represented Petitioner
DISTRICT COURT
CLARK COUNTY, NEVADA
In the Matter of the Application of:
___________________________________
(your name)
For the Correction of Birth Certificate and
Issuance of New Birth Certificate.
CASE NO.: ____________________
DEPT.: _____________________
COPY OF BIRTH CERTIFICATE
(file under seal)
Attached is a copy of the birth certificate with the incorrect information. This document
is to be kept confidential and filed under seal.
Submitted By: (your signature) _______________________________
(print your name
) _______________________________
/s/
© 2019 Family Law Self-Help Center Notice of Petition for Adult Name Change
1
NOTC
Your Name: _________________________
Address: ____________________________
City, State, Zip: ______________________
Phone: _____________________________
Email: ______________________________
Self-Represented Petitioner
DISTRICT COURT
CLARK COUNTY, NEVADA
In the Matter of the Application of:
___________________________________
(
your name)
For the Correction of Birth Certificate and
Issuance of New Birth Certificate.
CASE NO.: ____________________
DEPT: _____________________
NOTICE OF PETITION FOR CHANGE OF NAME
NOTICE IS HEREBY GIVEN that a petition was filed in the above-entitled Court
requesting that the Court legally change applicant’s name from
(clearly print the old name you do not want anymore)
_____________________ ______________________ _______________________
(first) (middle) (last)
to: (clearly print the name you want to be known by in the future)
_____________________ ______________________ _______________________
(first) (middle) (last)
The applicant submitted a statement signed under penalty of perjury that the applicant is
not changing his or her name for a fraudulent purpose.
NOTICE IS FURTHER GIVEN that any person objecting to the changing of
applicant’s name shall file written objection with the above-entitled Court within 10 days after
the publication of this Notice.
DATED _____________________________, 20____.
Submitted By: (your signature) _______________________________
(print your name) ___
____________________________
/s/
© 2019 Family Law Self-Help Center Birth Certificate Summary Disposition (Adult)
1
RSDN
Your Name: ________________________
Address: ___________________________
City, State, Zip: _____________________
Phone: ____________________________
Email: ____________________________
Self-Represented Petitioner
DISTRICT COURT
CLARK COUNTY, NEVADA
In the Matter of the Application of:
___________________________________
(your name)
For the Correction of Birth Certificate and
Issuance of New Birth
Certificate.
CASE NO.: ____________________
DEPT.: _____________________
REQUEST FOR SUMMARY DISPOSITION OF PETITION TO CORRECT BIRTH
CERTIFICATE AND DECLARATION IN SUPPORT
Petitioner (your name) ____________________________________ requests from this
Court a summary disposition for a correction of birth certificate without a hearing.
Submitted By: (your signature) _______________________________
(print your name
) _______________________________
/s/
Page 2 of 3 – Request for Summary Disposition – Birth Certificate Correction (Adult)
DECLARATION OF PETITIONER
Petitioner (your name) ____________________________________ respectfully states as
follows:
1. I am the Petitioner in this case. I am a resident of Clark County, Nevada. I first moved
to Clark County, Nevada on (date) ______________. I intend to live in Clark County,
Nevada indefinitely.
2. I have read the Petition to Correct Birth Certificate (Adult) in this case and can testify
that the allegations are true and correct to the best of my knowledge.
3. The following information on the birth certificate is incorrect and should be changed:
Mother’s Information is Incorrect. The mother’s name on the birth certificate is
incorrect and should be changed to (write the correct mother’s name):
____________________________________________________________________
(First) (Middle) (Last)
Father’s Information is Incorrect. The father’s name on the birth certificate is
incorrect and should be changed to (write the correct father’s name):
____________________________________________________________________
(First) (Middle) (Last)
Other. The birth certificate should be corrected to state that (explain what is
incorrect on the birth certificate and what changes need to be made)
Page 3 of 3 – Request for Summary Disposition – Birth Certificate Correction (Adult)
4. Petitioner’s Name Change (☒ check one)
No name change is requested.
I request that the Court change the name on my birth certificate from
(clearly print your old name you do not want anymore)
_____________________ ______________________ _______________________
(first) (middle) (last)
to (clearly print the name you want to be known by in the future)
_____________________ ______________________ _______________________
(first) (middle) (last)
I (☒ check one) have / have not been convicted of a felony. Any felony
convictions are described in the Petition for Change of Name, and I have submitted my
complete set of fingerprints as required.
I am not changing my name in order to defraud creditors or for some other fraudulent
reason.
I declare under penalty of perjury under the law of the State of Nevada that the foregoing is true
and correct.
DATED _____________________________, 20____.
Submitted By: (your signature) _______________________________
(print your name
) _______________________________
/s/
© 2019 Family Law Self-Help Center Order for Correction of Birth Certificate (Adult)
1
ORDR
Your Name: _________________________
Address: ____________________________
City, State, Zip: ______________________
Phone: _____________________________
Email: ______________________________
Self-Represented Petitioner
DISTRICT COURT
CLARK COUNTY, NEVADA
In the Matter of the Application of:
___________________________________
(your name)
For the Correction of Birth Certificate and
Issuance of New Birth Certificate.
CASE NO.: ____________________
DEPT.: _____________________
ORDER FOR CORRECTION OF BIRTH CERTIFICATE (ADULT)
This Order was submitted ( check one) after a hearing / without a hearing before
the above-entitled court, and after a review of the pleadings and papers on file and the testimony
given, if any, this Court finds that a clerical error was made on the original birth certificate of
the Petitioner, (you name) ___________________________________________, born on (date
of birth) ________________ at (hospital name) _______________________________ located
in (county where petitioner was born) __________________ County, State of _____________.
Petitioner has shown good cause to have the information on the birth certificate corrected and a
new birth certificate issued.
Page 2 of 3 - Order for Correction of Birth Certificate (Adult)
IT IS HEREBY ORDERED, ADJUDGED AND DECREED that the birth certificate
of the Petitioner, (your name) __________________________________________, shall be
corrected as to the name of the ( check one) mother / father. The name shall be corrected
from:
(Incorrect Name) ______________________________________________________________
(First) (Middle) (Last)
To:
(Correct Name) _______________________________________________________________
(First) (Middle) (Last)
IT IS HEREBY ORDERED, ADJUDGED AND DECREED that the birth certificate
of the Petitioner, (your name) __________________________________________, shall be
corrected as to the name of the ( check one) mother / father. The name shall be
corrected from:
(Incorrect Name) ______________________________________________________________
(First) (Middle) (Last)
To:
(Correct Name) _______________________________________________________________
(First) (Middle) (Last)
IT IS HEREBY ORDERED, ADJUGED AND DECREED that:
The name of the Petitioner shall remain the same.
The birth certificate of the Petitioner (your name) ___________________________,
shall be corrected as to the name of the Petitioner. The name shall be corrected from:
(Incorrect Name) ______________________________________________________________
(First) (Middle) (Last)
To:
(Correct Name) _______________________________________________________________
(First) (Middle) (Last)
Page 3 of 3 - Order for Correction of Birth Certificate (Adult)
IT IS FURTHER ORDERED, ADJUDGED AND DECREED that the following
corrections shall also be made to the above-named Petitioner’s birth certificate from (indicate
any other corrections, or write “n/a” if none):
(Incorrect Language): __________________________________________________________
(Write the mistake exactly as it appears on the birth certificate)
To:
(Correct Language): ____________________________________________________________
(Write the correct language exactly as it should appear on the birth
certificate)
IT IS FURTHER ORDERED, ADJUDGED AND DECREED that the Department of
Vital Statistics shall issue a new birth certificate for the above-named Petitioner reflecting the
corrections above.
DATED _____________________________, 20____.
____________________________________
DISTRICT COURT JUDGE
Submitted By: (your signature) _______________________________
(print your name) _______________________________
/s/
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Filing Fee: The filing fee is $270. About (Family Law Self Help Center)

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Completed 9 February 2021

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