Fillable PCON Self-Represented Petitioner DISTRICT COURT CLARK COUNTY, NEVADA (Family Law Self Help Center)

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PCON Self-Represented Petitioner DISTRICT COURT CLARK COUNTY, NEVADA (Family Law Self Help Center)

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© 2017 Family Law Self-Help Center Petition for Adult 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:
_
__________________________________
(print the old name you do not want anymore)
For Change of Name.
CASE NO.: ____________________
DEPT: _____________________
PETITION FOR ADULT NAME CHANGE
Petitioner respectfully states as follows:
1. Petitioner was born on (date of birth) ___________________________________ in
(city) ____________________, (state) ___________________________.
2. Petitioner has resided in Clark County, Nevada since (date) ____________________
and intends to live in Clark County, Nevada indefinitely.
3. Petitioner’s current legal name is: (clearly print the old name you do not want anymore)
_____________________ ______________________ _______________________
(first) (middle) (last)
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)
Page 2 of 3 - Petition for Adult Name Change
4. Petitioner wishes to assume the new name because: ( check one)
I want to change my name to conform to my gender identity.
Other: (explain why you want to change your name)
5. (☒ check one)
I have never been convicted of a felony.
I have been convicted of a felony. The details of my convictions are (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.
6. Petitioner is not requesting this name change to defraud creditors or for som
e other
fraudulent reason.
Petitioner requests that the court enter an order changing Petitioner’s nam
e to (print the new
name you want to assume) ______________________________________________________
and for such other relief as the Court finds to be just and proper.
DATED this (day) ______ day of (month) ___________________, 20____.
Submitted By: (your signature)
_______________________________
(print your name) _______________________________
/s/
Page 3 of 3 - Petition for Adult Name Change
VERIFICATION
Under penalties of perjury, I declare that I am the Petitioner in the above-entitled action;
that I have read the foregoing Petition and know the contents thereof; that the pleading is true of
my own knowledge, except for those matters therein contained stated upon information and
belief, and that as to those matters, I believe them to be true.
I declare under penalty of perjury under the law of the State of Nevada that the
foregoing is true and correct.
DATED this (day) ______ day of (month) ___________________, 20____.
Submitted By: (your signature) _______________________________
(print your name) _______________________________
/s/
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PCON Self-Represented Petitioner DISTRICT COURT CLARK COUNTY, NEVADA (Family Law Self Help Center)

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Completed 9 February 2021

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