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

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

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© 2017 Family Law Self-Help Center Summary Dispo. – Adult Name Change
1
RSD
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: _____________________
REQUEST FOR SUMMARY DISPOSITION OF PETITION FOR CHANGE OF NAME
AND DECLARATION IN SUPPORT
Petitioner requests a summary disposition for a change of name without a hearing.
Submitted By: (your signature) _______________________________
(print your name) _______________________________
/s/
Page 2 of 2 – Request for Summary Disposition – Adult Name Change
DECLARATION OF PETITIONER
Petitioner respectfully states as follows:
1. I am the Petitioner in this case. I first moved to Clark County, Nevada on (date)
______________. I intend to live in Clark County, Nevada indefinitely.
2. I live at (street address) ___________________________________________________,
(city) ________________________, Nevada, (zip code) ______________.
3. I have read the Petition for Change of Name in this case and can testify that the
allegations are true and correct to the best of my knowledge.
4. I request that the Court change my legal name from
(clearly print your 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)
5. I (☒ check one) have / have not been convicted of a felony. Any felony
convictions are described in the Petition for Change of Name, and I have submitted my
complete set of fingerprints as required.
6. I am not changing my name in order to defraud creditors or for some
other fraudulent
reason.
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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RSD 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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