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. – Family 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:
(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: _____________________
REQUEST FOR SUMMARY DISPOSITION OF PETITION FOR CHANGE OF NAME
AND DECLARATION IN SUPPORT
Petitioner(s) requests a summary disposition for a change of name without a hearing.
Submitted By: (your signature) _______________________________
(printed name) _______________________________
(spouse’s signature) _______________________________
(spouse’s printed name) _______________________________
Page 2 of 3 – Request for Summary Disposition – Family Name Change
DECLARATION OF PETITIONER(S)
Petitioner(s) (your current name) ______________________________, and (your spouse’s
current name, or “n/a”) _________________________________ respectfully states as follows:
1. I/we are the Petitioner(s) in this case. I/we first moved to Clark County, Nevada on
(date) ______________. I/we intend to live in Clark County, Nevada indefinitely.
2. I/we live at (street address) ________________________________________________,
(city) ________________________, Nevada, (zip code) ______________.
3. I/we 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/we request that the court enter an Order changing:
(your current name) __________________________________________’s name to
(your new name) _____________________________________________________, and
(spouse’s current name) ______________________________________’s name to
(spouse’s new name) _______________________________________________, and
(first child’s current name) ________________________________________’s name to
(first child’s new name) ________________________________________________ and
(second child’s current name) ______________________________________’s name to
(second child’s new name) ______________________________________________.
5. I/we (☒ check one) have / have not been convicted of a felony. Any felony
convictions are described in the Petition for Change of Name.
6. I/we are not changing the names in order to defraud creditors or for some other
fraudulent reason.
Page 3 of 3 – Request for Summary Disposition – Family Name Change
I/we 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) _______________________________
(printed name) _______________________________
(spouse’s signature) _______________________________
(spouse’s printed name) _______________________________
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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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