© 2017 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:
__________________________________
(print the old name you do not want anymore)
For Change of Name.
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 this (day) ______ day of (month) ___________________, 20____.
Submitted By: (your signature) _______________________________
(print your name) _______________________________
/s/
