Fillable PCON Self-Represented Petitioner DISTRICT COURT (Family Law Self Help Center)

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PCON Self-Represented Petitioner DISTRICT COURT (Family Law Self Help Center)

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© 2017 Family Law Self-Help Center Petition for Family Name Change
* 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
PCON
Your Name: ________________________
Address: ___________________________
City, State, Zip: _____________________
Phone: ____________________________
Email: ____________________________
Self-Represented Petitioner
DISTRICT COURT
CLARK COUNTY, NEVADA
In the Matter of the Application of:
(1
st
adult) ________________________________
And
(2
nd
adult) ________________________________
write “n/a” above if only 1 adult.
For Change of Name for Themselves and for the
Minor Children:
(1
st
child’s name) ___________________________
And
(2
nd
child’s name) __________________________
CASE NO.: ____________________
DEPT: _____________________
PETITION FOR CHANGE OF NAME FOR ADULT(S) AND MINOR CHILD(REN)
Petitioner(s) respectfully states as follows:
1. Petitioner. (the first adult requesting a name change).
Petitioner was born on (date of birth) ___________________________________ in
(city) ____________________, (state) ___________________________.
2. Petitioner’s current legal name is: (clearly print the old name you do not want anymore)
_____________________ ______________________ _______________________
(first) (middle) (last)
Page 2 of 6 - Petition for Family Name Change
Petitioner wishes to take a different name. The new name Petitioner would like to take
is: (clearly print the name you want to be known by in the future)
_____________________ ______________________ _______________________
(first) (middle) (last)
3. Petitioner (☒ check one) has / has not been convicted of a felony. If Petitioner
has been convicted of a felony, each offense, the date of conviction, and the county and
state of conviction are as follows: (list all felony convictions, including the offense, date
of conviction, and the county/state):
*If you have a felony conviction, a complete set of fingerprints taken in the manner
described by the Department of Public Safety must be provided at the time you file this
petition.
4. Co-Petitioner (the second adult requesting a name change).
Not applicable (go to section 7 if there is not a second adult requesting a
name change)
Co-Petitioner was born on (date of birth) ___________________________________ in
(city) ____________________, (state) ___________________________.
5. Co-Petitioner’s current legal name is: (clearly print the old name you do not want
anymore)
_____________________ ______________________ _______________________
(first) (middle) (last)
Co-Petitioner wishes to take a different name. The new name Co-Petitioner would like to
take is: (clearly print the name you want to be known by in the future)
_____________________ ______________________ _______________________
(first) (middle) (last)
Page 3 of 6 - Petition for Family Name Change
6. Co-Petitioner (☒ check one) has / has not been convicted of a felony. If Co-
Petitioner has been convicted of a felony, each offense, the date of conviction, and the
county and state of conviction are as follows: (list all felony convictions, including the
offense, date of conviction, and the county/state):
*If you have a felony conviction, a complete set of fingerprints taken in the manner
described by the Department of Public Safety must be provided at the time you file this
petition.
7. First Child. Petitioners are the parents of the first child who was born on (date of birth)
_____________________ in (city) _______________________, (state)
____________________. The child’s current legal name is (clearly print the child’s
current, full, legal name):
_____________________ ______________________ _______________________
(first) (middle) (last)
The new name requested is: (clearly print the new name you want the child to have)
_____________________ ______________________ _______________________
(first) (middle) (last)
8. Second Child. Petitioners are the parents of the second child who was born on (date of
birth) _____________________ in (city) _______________________, (state)
____________________. The child’s current legal name is (clearly print the child’s
current, full, legal name):
_____________________ ______________________ _______________________
(first) (middle) (last)
The new name requested is: (clearly print the new name you want the child to have)
_____________________ ______________________ _______________________
(first) (middle) (last)
Page 4 of 6 - Petition for Family Name Change
9. The children have not been convicted of a felony.
10. Parent’s Consent. (☒ check one)
Both parents are filing this Petition and consent to the child(ren)’s name change(s)
(go to #11).
Only one parent is filing this Petition. The other parent’s name is: (write the name of
the other parent) __________________________________________. (☒ check one)
The other parent is deceased.
The other parent’s rights were terminated on (date) ___________________. A
copy of the court order is attached.
The other parent is the father, there is no father listed on the birth certificate,
and the father’s identity is truly unknown.
The other parent’s location is unknown.
Other. (explain why the other parent is not signing this petition)
*Any living parent with parental rights must consent to a child’s name change. If the
other parent will not consent, you will have to arrange to have the parent personally
served with copies of the name change paperwork.
11. Reason. Petitioner(s) request the above name change) because (explain why you want to
change your names)
Page 5 of 6 - Petition for Family Name Change
12. Petitioner(s) and the child(ren) have resided in Clark County, Nevada since (date)
__________________ and intend to live in Clark County, Nevada indefinitely.
13. The name changes are not requested in order to defraud creditors or for some other
fraudulent reason.
WHEREFORE, Petitioner prays for an order changing the family’s names as indicated.
Date: ____________________________ Date: ____________________________
________________________________ ________________________________
(First Parent’s signature) (Second Parent’s signature)
________________________________ _________________________________
(First Parent’s printed name) (Second Parent’s printed name)
FIRST PETITIONER’S VERIFICATION
STATE OF NEVADA )
)
COUNTY OF CLARK )
(Parent’s name) _________________________________________ being first duly
sworn under penalty of perjury, deposes and says:
I am the Petitioner herein, and I have read the foregoing Petition and know the contents
thereof; that the pleading is true to the best of my own knowledge, except as to those matters
therein stated upon information and belief, and as to those matters, I believe them to be true.
________________________________
(Parent’s signature)
Signed and sworn to (or affirmed) before me on
(date) _____________ by (name) ____________________
Signature of notarial officer
Page 6 of 6 - Petition for Family Name Change
SECOND PETITIONER’S VERIFICATION
STATE OF NEVADA )
)
COUNTY OF CLARK )
(Parent’s name) ___________________________________________ being first duly
sworn under penalty of perjury, deposes and says:
I am the Petitioner herein, and I have read the foregoing Petition and know the contents
thereof; that the pleading is true to the best of my own knowledge, except as to those matters
therein stated upon information and belief, and as to those matters, I believe them to be true.
________________________________
(Parent’s signature)
Signed and sworn to (or affirmed) before me on
(date) _____________ by (name) ____________________
Signature of notarial officer
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PCON Self-Represented Petitioner DISTRICT COURT (Family Law Self Help Center)

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Completed 9 February 2021

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