SUPPLEMENTAL ATTACHMENT TO
PETITION FOR CHANGE OF NAME
(Declaration of Guardian)
(TYPE OR PRINT NAME) (SIGNATURE OF PETITIONER)
PETITION OF (Name of petitioner or petitioners):
CASE NUMBER:
DECLARATION OF GUARDIAN
Supplemental Attachment to Petition for Change of Name (Form NC-100)
Attachment of
(If you are petitioning as a guardian of a minor, you must use a separate supplemental
attachment for each minor whose name is to be changed.)
Petitioner (name):
ProbateJuvenile
The minor identified in item 7c is likely to remain under the guardian's care until the minor reaches the age of majority because
(explain):
I declare under penalty of perjury under the laws of the State of California that the information in the foregoing declaration is true and
correct.
Date:
7.
(3)
b.
c.
f.
Form Adopted for Mandatory Use
Judicial Council of California
NC-110G [New January 1, 2001]
Code of Civil Procedure, § 1275 et seq.
NC-110G
(4)
a.
Petitioner's address (street, city, county, and zip code):
Petitioner is the guardian of the following minor whose name is to be changed:
Name (present name of child):(1)
Address (street, city, county, and zip code):(2)
d. Petitioner was appointed guardian of the minor identified in item 7c by (specify):
Superior Court of California, County of (name):(1)
Department (check one):(2)
Case number (specify):
Date of appointment (specify):
e. The grandparents of the minor whose name is to be changed are (provide names and addresses, if known):
Grandfather (name):(1) (address):
Grandmother (name):(2) (address):
Grandfather (name):(3) (address):
Grandmother (name):(4) (address):
Continued (if you need additional space, check the box, prepare an Attachment 7f, and attach it to this declaration).
The minor identified in item 7c is not likely to be returned to the custody of his or her parents because (explain):
g.
Continued (if you need additional space, check the box, prepare an Attachment 7g, and attach it to this declaration).
Other relevant information about the guardianship and why the proposed name change is in the best interest of the minor
(specify):
h.
Continued (if you need additional space, check the box, prepare an Attachment 7h, and attach it to this declaration).
Guardian of (name of minor):
FOR CHANGE OF NAME
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