Fillable Name Change (adult)-with Minor Packet (Clerk of the Superior Court)

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Name Change (adult)-with Minor Packet (Clerk of the Superior Court)

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Revised 10.24.18
NAME CHANGE
FOR AN ADULT
(WITH MINOR CHILDREN)
PINAL COUNTY
TO MAKE A REQUEST FOR A CHANGE OF NAME FOR AN ADULT
WHO HAS MINOR CHILDREN
INSTRUCTIONS AND FORMS
Provided as a Public Service by
Amanda Stanford
Clerk of the Superior Court
Page 1 of 1
CV_NCAWM_COSCPinal_04.09.12
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APPLICATION FOR CHANGE OF NAME
OF AN ADULT WITH MINOR CHILDREN
CHECKLIST
USE THE FORMS AND INSTRUCTIONS in this packet only if the following factors apply to
your situation:
√ You want to ask the court to change your name,
AND
√ You are an adult 18 years or older,
AND
√ You have minor children.
NOTE:
For information regarding name changes that can be obtained without going to court, or to add
a name to, or change a name on a birth certificate, please contact the Arizona Department of Health
Services, Bureau of Vital Records at (602) 364-1237.
READ ME:
It is very important for you to know that when you sign a court document, you may
be helping or hurting your court case. Before you sign any court document, or get involved with a
court case, it is important that you see a lawyer to make sure you are doing the right thing.
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CV_NCAWM_COSCPinal_07.10.17
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PROCEDURES
HOW TO FILE FOR A CHANGE OF NAME WITH THIS COURT
FOR AN ADULT WITH MINOR CHILDREN
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 “Application for Change of Name for an Adult”, “Civil Cover Sheet”
and the “Notice of Hearing Regarding Application for Change of Name” (leave
date, time and location blank).
STEP 2: MAKE COPIES:
Make 2 copies of the “Application for Change of Name for an Adult”
STEP 3: FILE THE PAPERS AT THE COURT:
WHO:
GO TO:
Who must file the “Application for Name Change of an Adult”?
The adult, 18 years or older, seeking the name change, or their attorney,
must file the papers.
THE CLERK OF COURT TO FILE YOUR PAPERS:
FEES:
Please check with the Clerk’s office for the current filing fee. The fee is
payable to the Clerk of the Superior Court by cash, money order, Visa or
MasterCard or personal check with proper identification. If the filing fee
is a hardship and you think a fee deferral is appropriate, ask the staff at
the Customer Service Counter for an Application for Fee Deferral before
you file your Petition.
Note: With the Application for Deferral, you must provide proof of income
(copy of your last 2 most recent paystubs)
PAPERS: Give your original application and all copies to the Clerk along with the
filing fee. Make sure the filing clerk conforms (stamps) all of your
copies and returns them to you.
Visit our website for office locations or feel free to give us a call.
Contact Information for all Offices
Toll Free: 888.431.1311 • Local: 520.509.3555 or 311 • Fax: 520.866.5320
www.coscpinalcountyaz.gov/office.html
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CV_NCAWM_COSCPinal_07.10.17
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STEP 4: SCHEDULE YOUR HEARING AT THE TIME OF FILING:
After filing your application, the clerk will complete the “Notice of Hearing Regarding
Application for Change of Name” to show the date (depending on your method of
service), time, and place of your hearing. You must request copies of this form.
STEP 5: NOTIFY ANY INTERESTED PARTY:
WHO: You must notify your spouse, if you are married, about your request for
name change and the scheduled hearing. If you are not married but
have at least one minor child, you must also notify the other parent of
your child(ren).
HOW
TO NOTIFY:
If you know where the person lives, you can do one of the following:
1. IF
THE PERSON AGREES WITH YOUR REQUEST – Give the person a stamped
copy of your application and the “Notice of Hearing Regarding Application for
Change of Name” that shows the date, time, and place of your hearing. Then, if
the person agrees with your request, have the person complete the form entitled,
“Consent of Parent to Name Change of an Adult and Waiver of Notice” and
have it notarized. That document serves as your proof of notice.
Bring the signed
and notarized “Consent of Parent to Name Change of an Adult and Waiver of
Notice” to the hearing.
If
you are married to someone other than the parent of your minor child(ren), and
your spouse agrees with your request for a change of name, have your spouse
complete the “Consent of Spouse to Name Change of an Adult and Waiver of
Notice” and have it notarized. That document serves as your proof of notice.
Bring the signed and notarized “Consent of Spouse to Name Change of an
Adult and Waiver of Notice” to the hearing.
2. IF THE PERSON DOES NOT AGREE WITH YOUR REQUEST OR YOU ARE
NOT SURE IF THE PERSON AGREES - Give the person a stamped copy of your
application and the “Notice of Hearing Regarding Application for Change of
Name” that shows the date, time, and place of your hearing. Then, have the
person sign an “Acceptance of Service”. That notarized form serves as the proof
of notice. Bring the signed and notarized “Acceptance of Service” to the hearing;
OR,
3. Send a c
opy of your application bearing the Clerk’s stamp and the “Notice of
Hearing Regarding Application for Change of Name” showing the date, time,
and place of hearing by certified mail/restricted delivery
(return receipt requested).
This must be done at least 30 days before the hearing. Proof of notice for this step
is the card returned to you from the Post Office showing delivery. Bring the card
and a completed “Affidavit of Service by Certified Mail” to the hearing. The
person who should receive notice of the hearing must sign the return receipt.
If y
ou do NOT know where the person lives:
A Notice of Hearing that shows the date, time, and place of your hearing must be
published once in a newspaper of general circulation in Pinal County at least 14
days before the hearing. This is called notice by publication.
If notice is by publication, you must complete a notarized statement explaining in
detail what efforts you made to locate the person(s). Bring that statement with you
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CV_NCAWM_COSCPinal_07.10.17
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to the hearing. The Court will not accept notification by publication unless diligent
efforts have been made to locate the person for whom notification is required.
STEP 6: ATTEND THE HEARING:
WHO: All adults who are requesting a name change MUST be present at the
hearing.
BRING: These documents are required for your hearing:
• 2 copies of “Order Changing Name for an Adult”
• Photo identification for any person(s) who requests the change of
name
• Certified copy of birth certificate or proof of naturalization or resident
alien status (If applicable)
• A Clerk stamped copy of all filed documents
• Proof of Notice as described above in Step 5
• Divorce Decree (If applicable)
• Prior Name Change orders (If applicable)
• Copy of Orders of Protection and/or Injunctions Against Harassment
still in effect (If applicable)
• If the person requesting the change of name is not a United States
citizen, his/her passport or proof of immigration status must also be
provided at time of hearing.
AFTER THE HEARING:
If the Judge grants the name change(s), the Order Changing Name will be signed and
you will be directed to the Customer Service Counter to receive a conformed copy of
the Order.
You m
ay need to purchase a certified copy of the Order to complete the change of
name with other state and local government agencies.
Please check with the Clerk’s office for the current fee for purchasing a “Certified Copy”
of the Order Changing Name. The fee is payable to the Clerk of the Superior Court by
cash, money order, Visa or MasterCard.
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CV_ANCA_COSCPinal_10.24.17
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Name of Person Filing:
Street Address:
City, State, Zip Code:
Telephone Number:
Email Address:
ATLAS Number (if applicable)
Representing Self (No Attorney)
or Represented by Attorney
If Attorney, Bar Number:
SUPERIOR COURT OF ARIZONA
PINAL COUNTY
In the Matter of:
Name of Applicant
CASE NUMBER: S1100
CV2
APPLICATION FOR CHANGE OF NAME
FOR AN ADULT
HONORABLE:
STATEMENTS TO THE COURT, UNDER OATH
1. INFORMATION ABOUT ME, THE APPLICANT
Name on Birth Certificate or Current Legal Name:
Address:
Date of Birth:
Place of Birth:
County of Residence:
2. I ask that my name be changed to:
(First)
(Middle)
(Last)
I ask that the birth records be ordered changed to reflect the new name listed above.
3. REASON FOR THIS REQUEST FOR CHANGE OF NAME:
4. STATEMENTS TO THE COURT REQUIRED BY ARIZONA LAW
(A.R.S. §12-601(C))
Check the boxes that indicate a true statement.
a. I submitted this application solely for the benefit and in the best interest of the person for whom
the name change is requested.
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CV_ANCA_COSCPinal_10.24.17
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b. I understand and acknowledge that this change of name, if granted, will not release me from any
obligation incurred or harm any rights of property or action in any previous name.
c. I am not knowingly requesting this change of name to that of another individual for the purpose of
committing or furthering any offense of theft, forgery, fraud, perjury, organized crime or terrorism
or any other offense involving false statements.
d. Have you or any adult listed above ever been convicted of a felony? Yes No
If “yes”, list all felony convictions on next page.
If “Yes” to statement “d” all felony convictions are listed below.
Felony Case No. County and State Sentence Date of Conviction
1
2
3
4
Is there anything regarding your felony conviction(s) that you would like to bring to the Court’s attention?
(Optional)
e. Are there any criminal charges (felony or misdemeanor) pending against you at this time?
Yes No
I
f “Yes” to “e” all pending charges are listed below:
Pending Charges Name of Court or City & State Case No.
1
2
3
4
I
s there anything regarding your pending criminal charges that you would like to bring to the Court’s attention?
(Optional)
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CV_ANCA_COSCPinal_10.24.17
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OATH AND VERIFICATION OF APPLICANT:
I
, the Applicant, being duly sworn and under oath, state that I have read this Application. All the
statements in the Application are true, correct, and complete to the best of my knowledge and belief.
Date
Signature
State of Arizona )
)
County of )
(Arizona County)
Subscribed and sworn (or affirmed) before me this
day
,
20
(Day)
(Month)
(Year)
by
(Name of Signer)
Seal (Affix notary seal here)
Notary Public (Notary’s Signature)
September 26, 2018 Page 1 AOCCV10F-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*
Reset Form
September 26, 2018 Page 2 AOCCV10F-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)
_________________________________________________________________________________________
_________________________________________________________________________________________
Page 1 of 1
CV_NHRANC_COSCPinal_10.24.17
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Name of Person Filing:
Street Address:
City, State, Zip Code:
Telephone Number:
Email Address:
ATLAS Number (if applicable)
Representing Self (No Attorney)
or Represented by Attorney
If Attorney, Bar Number:
SUPERIOR COURT OF ARIZONA
PINAL COUNTY
In the Matter of:
Name(s) of person(s) requesting name change
CASE NUMBER: S1100
CV2
NOTICE OF HEARING REGARDING
APPLICATION FOR CHANGE OF NAME
HONORABLE:
READ THIS NOTICE CAREFULLY. An important court proceeding that affects your rights has been
scheduled. If you do not understand this Notice or the other court papers, contact an attorney for legal advice.
1. NOTICE IS GIVEN that the Applicant has filed with the Court an Application for Change of Name. At
the hearing, the Court will consider whether to grant or deny the requested name change. If you wish t
o
be
heard on this issue, you must appear at the scheduled hearing.
2. COURT HEARING. A court hearing has been scheduled to consider the Application as outlined below:
DATED:
(Month/Day/Year)
(Applicant’s Signature)
THE COURT COMPLETES THE FOLLOWING SECTION
DATE:
TIME:
LOCATION:
Pinal County Justice Complex - 971 N Jason Lopez Circle, Bldg A – Florence AZ 85132
BEFORE THE HONORABLE:
Page 1 of 2
CV_CNCAWN_COSCPinal_10.24.17
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Name of Person Filing:
Street Address:
City, State, Zip Code:
Telephone Number:
Email Address:
ATLAS Number (if applicable)
Representing Self (No Attorney)
or Represented by Attorney
If Attorney, Bar Number:
SUPERIOR COURT OF ARIZONA
PINAL COUNTY
In the Matter of:
Name of Applicant
CASE NUMBER: S1100
CV2
CONSENT OF SPOUSE TO
NAME CHANGE OF AN ADULT AND
WAIVER OF NOTICE
HONORABLE:
REQUIRED INFORMATION FROM SPOUSE, UNDER OATH:
1. INFORMATION ABOUT ME:
Name:
Address:
Telephone:
Date of Birth:
The applicant and I have at least one child in common.
2. I
have read the Application for Name Change and I consent to my spouse changing their name to:
(First)
(Middle)
(Last)
3. I
waive notice of all further proceedings in this matter.
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CV_CNCAWN_COSCPinal_10.24.17
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OATH OF PARENT:
I have read, understood, and completed the above statements. Everything I have said is true and correct
to the best of my knowledge, information and belief.
Date
Signature
State of Arizona )
)
County of )
(Arizona County)
Subscribed and sworn (or affirmed) before me this
day
,
20
(Day)
(Month)
(Year)
by
(Name of Signer)
Seal (Affix notary seal here)
Notary Public (Notary’s Signature)
Page 1 of 1
CV_ASCM_COSCPinal_10.24.17
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Name of Person Filing:
Street Address:
City, State, Zip Code:
Telephone Number:
Email Address:
ATLAS Number (if applicable)
Representing Self (No Attorney)
or Represented by Attorney
If Attorney, Bar Number:
SUPERIOR COURT OF ARIZONA
PINAL COUNTY
In the Matter of:
Name of Applicant
CASE NUMBER: S1100
CV2
AFFIDAVIT OF SERVICE BY
CERTIFIED MAIL
HONORABLE:
1. I
am familiar with the facts stated in this Affidavit, and I make this Affidavit to show that I have served copies
of the “Application for Change of Name” and the “Notice of Hearing Regarding Application for Change
of Name” on the person named below by certified mail/restricted delivery, return receipt requested.
Person served (name of other party):
Address where other party was served:
Date of receipt by the other party:
2. T
he Application and Notice listed above were received by the other party as shown by the receipt, the original
of which is attached to this Affidavit on a separate piece of paper.
I
swear or affirm that the information on this document is true and correct under penalty of perjury.
Date
Signature
State of Arizona )
)
County of )
(Arizona County)
Subscribed and sworn (or affirmed) before me this
day
,
20
(Day)
(Month)
(Year)
by
(Name of Signer)
Seal (Affix notary seal here)
Notary Public (Notary’s Signature)
Page 1 of 1
CV_ONCA_COSCPinal_10.24.17
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SUPERIOR COURT OF ARIZONA
PINAL COUNTY
In the Matter of:
Name of Applicant
CASE NUMBER: S1100
CV2
ORDER CHANGING NAME OF AN ADULT
HONORABLE:
THE COURT FINDS:
1. This case has come before this Court to Change the Name of the Applicant above.
2. This Court has jurisdiction to change the name of the Applicant.
3. Good cause exists to grant the application for Change of Name.
4. It is in the best interest of the Applicant to change his/her name as set forth below.
IT IS HEREBY ORDERED:
1. The name on the Birth Certificate OR the Current Legal Name:
(First)
(Middle)
(Last)
Date of Birth:
Place of Birth:
IS CHANGED TO:
(First)
(Middle)
(Last)
2. For the person born in the State of Arizona, the Office of Vital Records is ordered to amend the birth
record to reflect the new name as ordered above.
For the person born in a state other than Arizona, to the extent that the agency that maintains birth
records in that state is authorized to honor an order of this Court, that agency is requested or ordered to
amend its birth records to reflect the new name as ordered above.
3. T
his Order does not release the Applicant from any obligation or harm any rights of property or action i
n
an
y original name.
4. Other orders:
DONE IN OPEN COURT this
day of
20
(Superior Court Judge/Special Commissioner)
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Name Change (adult)-with Minor Packet (Clerk of the Superior Court)

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Completed 24 July 2020

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