© 2017 Family Law Self-Help Center Notice of Petition for Adult Name Change (Adoption)
1
NOTC
Your Name: ________________________
Address: ___________________________
City, State, Zip: _____________________
Phone: ____________________________
Email: ____________________________
Self-Represented Petitioner
DISTRICT COURT
CLARK COUNTY, NEVADA
In the Matter of the Petition of
_________________________________ and
_________________________________
(adoptive parents’ name(s))
For the adoption of
_________________________________,
(name of person to be adopted)
An adult.
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.
