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EIGHTH JUDICIAL DISTRICT COURT
CLARK COUNTY, NEVADA
FAMILY COURT COVER SHEET
CASE NO.
(To be assigned by the Clerk’s Office)
Do you or any other party in this case (including any minor child) have any other current case(s) or past
case(s) in the Family Court or Juvenile Court in Clark County?
YES
NO
If yes, complete the other side of this form
PARTY INFORMATION (Please Print)
Plaintiff/Petitioner
Defendant/Respondent/Co-Petitioner/Ward/Decedent
Last Name:
Last Name:
First Name:
Middle Name:
First Name:
Middle Name:
Home Address:
Home Address:
City, State, Zip:
City, State, Zip:
Mailing Address:
Mailing Address:
City, State, Zip:
City, State, Zip:
Phone #:
Date of Birth:
Phone #:
Date of Birth:
Attorney Information
Name:
Attorney Information
Bar No.
Name:
Bar No:
Address:
Address:
City, State, Zip:
City, State, Zip:
Phone #:
Phone #:
(Check one box only for the type of case being filed with this cover sheet)
DOMESTIC
Marriage Dissolution
Annulment
Divorce –No minor child(ren)
Divorce –With minor child(ren)
Foreign Decree
Joint Petition –No minor child(ren)
Joint Petition – With minor child(ren)
Separate Maintenance
OTHER DOMESTIC RELATIONS
PETITIONS
Adoption –Minor
Adoption –Adult
Child Custody (Non-Divorce)
Mental Health
Name Change
Paternity
Permission to Marry
Support - Other
Temporary Protective Order (TPO)
Termination of Parental Rights
Visitation (Non-Divorce)
Other (identify) __________________
MISC. JUVENILE PETITIONS
Work Permit
Emancipation
GUARDIANSHIP
PROBATE
Guardianship of an Adult
Person
Estate
Person and Estate
Guardianship of a Minor
Person
Estate
Person and Estate
Summary Administration
General Administration
Special Administration
Set Aside Estates
Trust/Conservatorships
Individual Trustee
Corporate Trustee
Other Probate
Guardianship Trust
IV-D CHILD SUPPORT PETITIONS
DA – UIFSA
Child Support In State IV-D
List children involved in this case (If more than 3 children, please enter the information on the reverse side)
Last Name
First Name
Middle Name
Date of Birth
Relationship
1.
2.
3.
_________________________________
Printed Name of Preparer
Revised 07/01/12
Eighth Judicial District Court
Pursuant to NRS 3.275
__________________________________
Signature of Preparer
________________
Date
Supply the following information about any other proceeding (check all that apply):
Divorce
Temporary Protective Orders (TPO)
UIFSA/URESA
Paternity
Custody/Child Support
Juvenile Court
Other
Middle Name
Case number
of other
proceeding(s)
Please Print
List full name of all adult parties involved
Last Name
First Name
Approximate date
of last order in
other proceeding(s)
1.
2.
3.
4.
If children were involved (other than those listed on front page), please provide:
Last Name
First Name
Middle Name
Date of Birth
Relationship
1.
2.
3.
4.
5.
6.
7.
8.
Children involved in this case (continuation from front page)
Last Name
First Name
Middle Name
Date of Birth
4.
5.
6.
7.
8.
THIS INFORMATION IS REQUIRED BY
NRS 3.025, NRS 3.223, NRS 3.227, NRS 3.275,
NRS 125.130, NRS 125.230,
And will be kept in a confidential manner by the Clerk’s Office.
Relationship
PETITION FOR CHANGE OF NAME
(FOR MINOR CHILDREN)
EXPLANATION FOR PETITION FOR CHANGE OF NAME
A case for a change of name is started by filing a Petition
with the Court.
Certain information must be contained in
the Petition.
The forms that have been provided in this
package include the necessary information.
YOU CAN USE THIS PETITION FOR CHANGE OF NAME IF:
•
You and the child(ren) have lived in Clark County,
Nevada, for at least six weeks before you file the
Petition, and you plan to live in Clark County, Nevada
for the foreseeable future after the Petition is
filed.
•
You want to change the name of your child(ren).
not use this form if you want to change your name.
•
Neither you nor the child(ren) have been convicted of
a felony. Do not use this form if either you or your
child(ren) have been convicted of a felony. If either
of you have been convicted of a felony, you should
speak with an attorney to see what steps should be
taken to ask the Court to change your child(ren)’s
name.
•
You are not changing your child(ren)’s
avoid creditors or to defraud someone.
name(s)
Do
to
Note: If you are correcting a first or middle name (only)
and the children were born in Nevada, you may not need to
go through the court process.
Please ask a Self-Help
Center staff member for assistance.
 Clark County Family Law Self-Help Center
Minor\Namechmi.3pam (#7)
August 27, 2003
Use only the most current version
ALL RIGHTS RESERVED
Please call the Self-Help Center to confirm most current version
These forms can be filled out online.
To begin, left click on the first line.
In order to move to the next line hit
the "tab" key.
1
INSTRUCTIONS FOR PETITION FOR CHANGE OF NAME
(FOR MINOR CHILDREN)
* * * IMPORTANT DISCLOSURE * * *
THIS INFORMATION IS PROVIDED AS A COURTESY ONLY. THE SELF-HELP
CENTER SHALL NOT BE LIABLE FOR ERRORS CONTAINED HEREIN OR FOR
DIRECT, INDIRECT, SPECIAL OR CONSEQUENTIAL DAMAGES IN CONNECTION
WITH THE FURNINSHING OF THIS MATERIAL.
MANY FAMILY LAW MATTERS INVOLVE COMPLEX AND VALUABLE LEGAL
RIGHTS. THESE FORMS AND INSTRUCTIONS ARE BASIC, GENERAL FORMS, AND
MAY NOT FIT ALL SITUATIONS. SOME RIGHTS CANNOT BE ADEQUATELY
PROTECTED WITHOUT THE ASSISTANCE OF AN ATTORNEY. YOU SHOULD
CONSULT WITH AN ATTORNEY BEFORE YOU ATTEMPT TO USE SELF-HELP.
* * * * *
I.
EXPLANATION OF PETITION FOR CHANGE OF NAME
A.
A case for a change of name is started by filing a Petition with the Court. Certain
information must be contained in the Petition. The forms that have been provided in
this package include the necessary information.
B.
You can use this Petition for Change of Name if:
• You and the child(ren) have lived in Clark County, Nevada, for at least six
weeks before you file the Petition, and you plan to live in Clark County,
Nevada, for the foreseeable future after the Petition is filed.
• You want to change the name of your child(ren). Do not use this form if you
want to change your name.
• Neither you nor the child(ren) have been convicted of a felony. Do not use this
form if either you or your child(ren) has been convicted of a felony. If either of
you have been convicted of a felony, you should speak with an attorney to see
what steps should be taken to ask the Court to change your child(ren)’s name(s).
• You are not changing your child(ren)’s name(s) to avoid creditors or to defraud
someone.
©Clark County Family Law Self-Help Center
August 29, 2003
ALL RIGHTS RESERVED
minor\ namechmi.9in (#7)
Use only most current version
Please call the Self-Help Center to confirm most current version.
2
Note: If you are correcting a first or a middle name (only) and the child(ren)
were born in Nevada, you may not need to go through the court process. Please
ask a Self-Help Center staff member for assistance.
C.
This package should contain the following documents:
• Family Court Cover Sheet
• Instructions for Petition for Change of Name (For Minor Child(ren))
• Petition for Change of Name
• Two Applications for Appointment as Guardian Ad Litem – you must choose
which Application you want to use.
--One Application should be used when the child is at least 14 years old.
--The other Application should be used when the child is younger than 14 years
old.
• Order Appointing Guardian Ad Litem
• Consent for Change of Name
• Notice of Petition for Change of Name
• Two Orders for Change of Name - you must choose which Order you want to
use.
--One Order will not “erase” the child’s old name from the birth certificate at
the Department of Vital Statistics. The Department of Vital Statistics will put
your child’s new name in the birth certificate as an “aka”.
©Clark County Family Law Self-Help Center
August 29, 2003
ALL RIGHTS RESERVED
minor\ namechmi.9in (#7)
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3
--The other Order will tell the Department of Vital Statistics to issue a
completely new birth certificate that does not have your child’s old name on
it.
• Request for Summary Disposition
• Affidavit of Petitioner
• Court class information flier
• List of filing fees from the Clerks Office
• List of telephone numbers for the judges’ staffs and the Court Clerks
Note: this package is designed to change up to two children’s names. If you
only want one child’s name to be changed, write “N/A” on the blanks that
pertain to the second child.
II.
STEP 1: PREPARE YOUR PAPERWORK
NOTE: WHEN FILLING OUT ANY FORM, YOU MUST USE BLACK INK. PRINT
CLEARLY. THE CLERKS OFFICE WILL NOT FILE YOUR DOCUMENT IF THE
HANDWRITING IS HARD TO READ.
A.
THE FAMILY COURT COVER SHEET:
1. The Family Court Cover Sheet is a document use by the Clerks Office to
create a file for your case.
2. Complete the front side of the sheet.
©Clark County Family Law Self-Help Center
August 29, 2003
ALL RIGHTS RESERVED
a.
Leave the “Case No.” blank. The Clerks Office will give you a
case number and department letter when you file the petition.
b.
Insert the requested information into the grids. If something
does not apply, write “N/A”.
minor\ namechmi.9in (#7)
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4
i.
The last grid pertains to children that you and the
Defendant have together.
Do not include step
children in this grid. If you and the Defendant have
more than four children together, please go to the back
page and complete the bottom grid.
c.
Check the box next to the type of case you will be filing.
d.
Print and sign your name.
e.
Check either the “Yes” or “No” box on the bottom of the page.
If you check “Yes,” please complete the back of the form. If
you checked “No” and have less than four children together,
stop.
3. Complete the back of the Family Court Cover Sheet (if necessary).
a.
B.
Check all boxes that apply and insert the requested
information. If something does not apply, write “N/A”. Case
numbers for previous cases can be found on the Clerks Office’s
Web site: http://www.co.clark.nv.us/clerk/clerkhome.htm
i.
For the middle grid, list children that are either yours or
the Defendant’s, but not children that you had together.
Insert the child’s relationship to the biological parent
(i.e., “defendant’s son”).
ii.
Use the bottom grid only if you and Defendant have
more than four children together. This grid is a
continuation of the bottom grid on the first page.
THE CAPTION:
1. The “caption” is the portion of your document, which assists the Court in
identifying your particular case. It is the part of the page that says “In the
Matter of the Application of _____.” Generally, this caption will remain
the same throughout the entire case and will be on every document filed in
©Clark County Family Law Self-Help Center
August 29, 2003
ALL RIGHTS RESERVED
minor\ namechmi.9in (#7)
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Please call the Self-Help Center to confirm most current version.
5
this action. In this package, the caption in on the: (a) Petition, (b)
Application for Appointment of Guardian Ad Litem, (c) Order Appointing
Guardian Ad Litem, (d) Consent for Change of Name, (e) Notice of
Petition for Change of Name, (f) Request for Summary Disposition, (g)
Affidavit of Petitioner, and (h) Order Changing Name.
C.
THE PETITION:
1. Insert your name, address, and phone number on the first page, upper lefthand corner. Insert your current name on the blank line over the words
“Your name” in the caption. Insert your child’s current name on the blank
line over the words “First child’s name.” If you are changing a second
child’s name, insert that child’s current name on the blank above the
words “Second child’s name.”
2. Leave the lines to the right of the caption blank. The Clerks Office will
give you a case number and department number when you file the
Petition. Once you get the case number from the Clerk, you will need to
put it on any documents that you give to the Court (i.e., the Order that the
judge will sign, etc.).
3. The Petition uses a fill-in-the-blank format. The Petition will tell you
want information you need to put into the blank (i.e., your child’s current
name, the name you want the child to have, etc.). If the Petition tells you
to check an item, check the item that applies (i.e., check either “him” or
“her” if the Petition has “him/her”).
4. The Petition must be “verified.” In other words, you will need to sign the
Petition in front of a Notary Public. The Self-Help Center has a Notary
available. The Petition will also have to be “acknowledged” by the
Notary. The Notary will know what to do. Do not make any copies until
the document has been notarized.
D.
THE NOTICE:
1. Insert your name, address, and phone number on the first page, upper lefthand corner. Insert your current name on the blank line over the words
“Your name” in the caption. Insert your child’s current name on the blank
line over the words “First child’s name.” If you are changing a second
©Clark County Family Law Self-Help Center
August 29, 2003
ALL RIGHTS RESERVED
minor\ namechmi.9in (#7)
Use only most current version
Please call the Self-Help Center to confirm most current version.
6
child’s name, insert that child’s current name on the blank above the
words “Second child’s name.”
2. Leave the lines to the right of the caption blank. The Clerks Office will
give you a case number and department number when you file your
Petition.
3. The Notice also uses a fill-in-the-blank format. The Notice will tell you
what information you need to put into the blank.
E.
THE ORDER:
1. Insert your current name on the blank line over the words “Your name” in
the caption. Insert your child’s current name on the blank line over the
words “First child’s name.” If you are changing a second child’s name,
insert that child’s current name on the blank above the words “Second
child’s name.”
2. The Order also uses a fill-in-the-blank format. The Order will tell you
what information to you need to put into the blank.
3. After you have filed the Petition, fill in the case number on the line after
“CASE NO.” and the department letter on the after “DEPT. NO.”
F.
THE APPLICATION FOR APPOINTMENT AS GUARDIAN AD LITEM:
Note: Some departments require that a guardian as litem be appointed to represent a
child when that child’s name is going to changed. After you have filed your Petition
(see Section III, below), you should call the law clerk for the department that your
case is assigned to and ask whether or not that department requires this procedure.
There are two forms for the Application for Appointment as Guardian Ad Litem in
this package. Only complete the form that applies to you situation. ONLY
COMPLETE ONE OF THESE FORMS IF THE DEPARTMENT THAT
YOUR CASE IS ASSIGNED TO REQUIRES THE APPOINTMENT OF A
GUARDIAN AD LITEM. (PLEASE SEE SECTION IV, BELOW.)
1. Insert your name, address, and phone number on the first page, upper lefthand corner. Insert your current name on the blank line over the words
“Your name” in the caption. Insert your child’s current name on the blank
©Clark County Family Law Self-Help Center
August 29, 2003
ALL RIGHTS RESERVED
minor\ namechmi.9in (#7)
Use only most current version
Please call the Self-Help Center to confirm most current version.
7
line over the words “First child’s name.” If you are changing a second
child’s name, insert that child’s current name on the blank above the
words “Second child’s name.
2. Insert the case number on the line after “CASE NO.” and the department
letter on the line after “DEPT. NO.”
3. The Application for Appointment of Guardian Ad Litem uses a fill-in-theblank format. The Application will tell you what information you need to
put into the blank. The children must sign the Application before a
Notary, if they are at least 14 years old. The Notary will require
identification that contains both a picture and that person’s signature. For
a child, school identification cards are acceptable if the child’s signature is
on that card.
G.
THE ORDER APPOINTING GUARDIAN AD LITEM:
ONLY COMPLETE THIS FORM IF THE DEPARTMENT THAT YOUR
CASE IS ASSIGNED TO REQUIRES THE APPOINTMENT OF A
GUARDIAN AD LITEM. (PLEASE SEE “F”, ABOVE.)
1. Insert your name, address, and phone number on the first page, upper lefthand corner. Insert your current name on the blank line over the words
“Your name” in the caption. Insert your child’s current name on the blank
line over the words “First child’s name.” If you are changing a second
child’s name, insert that child’s current name on the blank above the
words “Second child’s name. If you are not changing a second child’s
name, write “N/A” on the blank.
2. Insert the case number on the line after “CASE NO.” and the department
letter on the line after “DEPT. NO.”
3. The Order Appointing Guardian Ad Litem uses a fill-in-the-blank format.
The Order will tell you what information you need to put into the blank.
©Clark County Family Law Self-Help Center
August 29, 2003
ALL RIGHTS RESERVED
minor\ namechmi.9in (#7)
Use only most current version
Please call the Self-Help Center to confirm most current version.
8
H.
THE CONSENT TO NAME CHANGE:
Note: Some departments require that the parent who is not the petitioner sign a
consent form. After you have filed your Petition (see Section III, below), you
should call the law clerk for the department that your case is assigned to and ask
whether or not that department requires a consent. If the department requires a
consent and you cannot obtain that consent, you will need to ask the judge’s law
clerk what steps you need to take. Lists of telephone numbers for the judges’ staffs
are included in this package. ONLY COMPLETE ONE OF THESE FORMS IF
THE DEPARTMENT THAT YOUR CASE IS ASSIGNED TO REQUIRES
THE OTHER PARENT GIVE CONSENT TO THE CHILD(REN)’S NAME
CHANGE AND THAT PARENT IS WILLING TO SIGN THE CONSENT
FORM. THAT PARENT WILL NEED TO SIGN THE FORM IN FRONT OF
A NOTARY AND IN FRONT OF TWO WITNESSES.
1. Insert your name, address, and phone number on the first page, upper lefthand corner. Insert your current name on the blank line over the words
“Your name” in the caption. Insert your child’s current name on the blank
line over the words “First child’s name.” If you are changing a second
child’s name, insert that child’s current name on the blank above the
words “Second child’s name.
2. Insert the case number on the line after “CASE NO.” and the department
letter on the line after “DEPT. NO.”
3. The Consent uses a fill-in-the-blank format. The Consent will tell you
what information goes into the blank.
4. The parent who is not the Petitioner will fill in the blanks under the title
“Consent to Name Change” through the signature line on page 2. The
parent signing the consent form must sign it before a notary and
before two witnesses.
5. The witnesses will sign their names under the word “attest” on the second
page. They will also print the information requested in the paragraphs
under the words “State of Nevada/County of Clark.” The witnesses will
sign their name and print their names underneath the signatures. The
witnesses must sign the consent form before a notary and before the
parent who signed the consent form.
©Clark County Family Law Self-Help Center
August 29, 2003
ALL RIGHTS RESERVED
minor\ namechmi.9in (#7)
Use only most current version
Please call the Self-Help Center to confirm most current version.
9
I.
THE REQUEST FOR SUMMARY DISPOSITION:
NOTE: THERE ARE TWO WAYS TO ASK THE COURT TO REVIEW
YOUR PAPERWORK: 1) “PROVE UP” HEARING; AND 2) “SUMMARY
DISPOSITION”. ONLY COMPLETE THIS FORM IF YOU ARE GOING
TO ASK THE COURT TO REVIEW YOUR PAPERWORK BY SUMMARY
DISPOSITION. YOU SHOULD COMPLETE THIS FORM AFTER YOU
HAVE FILED THE PETITION. (PLEASE SEE SECTION VI., BELOW.)
NOTE:
SOME DEPARTMENTS DO NOT USE THE SUMMARY
DISPOSITION METHOD FOR NAME CHANGES. YOU CAN CALL THE
LAW CLARK FOR THE DEPARTMENT THAT YOUR CASE IS
ASSIGNED TO AND ASK FOR THAT DEPARTMENT’S POLICY.
1. Insert your current name, address, and phone number on the first page,
upper left-hand corner. Insert your current name on the blank line over the
words “Your name” in the caption. Insert your child’s current name on
the blank line over the words “First child’s name.” If you are changing a
second child’s name, insert that child’s current name on the blank above
the words “Second child’s name.
2. Insert the case number on the line after “CASE NO.” and the department
letter on the line after “DEPT. NO.”
3. The Request for Summary Disposition uses a fill-in-the-blank format. The
form will tell you what information you need to put into the blank.
J.
THE AFFIDAVIT OF PETITIONER:
NOTE: ONLY COMPLETE THIS FORM IF YOU ARE GOING TO ASK
THE COURT TO REVIEW YOUR ORDER BY SUMMARY DISPOSITION.
1. Insert your current name, address, and phone number on the first page,
upper left-hand corner. Insert your current name on the blank line over the
words “Your name” in the caption. Insert your child’s current name on
the blank line over the words “First child’s name.” If you are changing a
second child’s name, insert that child’s current name on the blank above
the words “Second child’s name.
©Clark County Family Law Self-Help Center
August 29, 2003
ALL RIGHTS RESERVED
minor\ namechmi.9in (#7)
Use only most current version
Please call the Self-Help Center to confirm most current version.
10
2. Insert the case number on the line after “CASE NO.” and the department
letter on the line after “DEPT. NO.”
3. The Affidavit of Petitioner uses a fill-in-the-blank format. The form will
tell you what information you need to put into the blank. Do not make
any copies until the document is notarized.
III.
IV.
STEP 2: FILE THE PETITION FOR CHANGE OF NAME AND THE NOTICE OF
PETITION FOR CHANGE OF NAME
A.
Make three copies of the Petition and Notice of Petition.
B.
You need to use a two-hole punch on the top of each original document and also
stamp or write “original” on each original document in between the two holes. The
Self-Help Center has a two-hole punch and a stamp that you can use.
C.
Take the completed Petition, the Notice of Petition, and money to pay the filing fee
with you to the Clerks Office (located on the first floor of the courthouse). The list
of filing fees for the Clerks Office is included in this package or you can call the
Clerks Office at 455-2590. The Clerks Office will take cash, money orders,
cashier’s checks, and personal checks if you have a valid Nevada Driver’s License.
D.
Go to the filing counter at the Clerks Office. The Clerk will file the original Petition
and the original Notice of Petition. He/she will stamp your copies and return them
to you. These are called “file-stamped” copies. The Clerk will also assign your case
to a judge (also know as a “department”) and give your case a “case number.”
STEP 3: ASK THE COURT TO APPOINT YOU AS YOUR CHILD(REN)’S
GUARDIAN AD LITEM (IF NECESSARY) AND FILE THE CONSENT (IF
NECESSARY)
NOTE: NOT ALL DEPARTMENTS REQUIRE AN APPOINTMENT OF A
GUARDIAN AD LITEM OR A CONSENT FROM THE NON-PETITIONING
PARENT. YOU SHOULD CALL THE LAW CLERK FOR THE DEPARTMENT
YOUR CASE HAS BEEN ASSIGNED TO AND ASK IF A GUARDIAN AD LITEM
AND/OR A CONSENT IS NEEDED. IF NEITHER FORM IS NEEDED, GO TO
SECTION V, BELOW.
©Clark County Family Law Self-Help Center
August 29, 2003
ALL RIGHTS RESERVED
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A.
For an Application for Appointment of Guardian Ad Litem, you will need to do the
following:
1. Complete the paperwork. (Please see Section II, F, above.)
2. Make three copies of the Application for Appointment as Guardian Ad
Litem and three copies of the Order Appointing Guardian Ad Litem.
3. You need to use a two-hole punch on the top of each original document
and also stamp or write “original” on each original document in between
the two holes. The Self-Help Center has a two-hole punch and a stamp
that you can use.
4. Take the completed Application for Appointment as Guardian Ad Litem
and Order Appointing Guardian Ad Litem to the filing counter at the
Clerks Office.
The Clerk will file the original Application for
Appointment as Guardian Ad Litem and will return the file-stamped
copies to you.
5. Go somewhere where you can put your documents together. You will
need to make a package for the judge’s office to review. That package
needs to have the following documents:
• One file-stamped copy of the Petition for Change of Name
• One file-stamped copy of the Notice of Petition for Change
of Name
• One file-stamped copy of the Application for Appointment
as Guardian Ad Litem
• The original Order Appointment Guardian Ad Litem and at
least three copies of the Order
©Clark County Family Law Self-Help Center
August 29, 2003
ALL RIGHTS RESERVED
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Please call the Self-Help Center to confirm most current version.
12
6. Next, take the elevator to the third floor of the courthouse. Go to the
reception area by “chambers.” You will see brown boxes against the wall.
Each box is marked with a department letter. Put the judge’s package into
the box belonging to that department.
7. The judge’s staff will review your paperwork. If it is approved, the judge
will sign the Order appointing you as the Guardian Ad Litem. If you need
to make corrections, the staff will put a note on your papers to tell you
how to correct your papers. It usually takes between one-to-two weeks
from the time that you give your papers to the department until the staff
has reviewed them.
8. The Court does not mail paperwork back to you. After one week, you can
call the Clerk’s Office at 455-2590 or go to the Clerks Office filing
counter to see if your paperwork is ready to be picked up. Tell the Clerk
that you are in “Proper Person” so he/she knows where to look for your
paperwork. If the paperwork is not in the Clerk’s Office after two weeks,
you may call the judge’s office to make sure that they have received your
paperwork. A listing of telephone numbers for the judge’s staffs is
included with this package.
9. If the judge signed the Order, the Clerk’s Office will automatically file it
for you. If your paperwork needs correction, you will need to follow the
instructions from the judge’s office and go through step 5 through 8 again
after you have made the correction.
B.
If you need the other parent to sign a Consent, you will need to do the following:
1. Complete the paperwork. (Please see Section II, H, above.)
2. Make three copies of the Consent.
3. Take the original Consent and the copies to the filing counter at the Clerks
Office. The Clerk will file the original Consent and return the filestamped copies to you.
©Clark County Family Law Self-Help Center
August 29, 2003
ALL RIGHTS RESERVED
minor\ namechmi.9in (#7)
Use only most current version
Please call the Self-Help Center to confirm most current version.
13
V.
STEP 4: PUBLISH THE NOTICE OF PETITION
A.
You must publish the Notice of Petition in a newspaper of general circulation in
Clark County one time per week for three weeks in a row. You may use any
newspaper of general circulation, but most people use Nevada Legal News, the
Review-Journal, of the Sun. You will need to call the papers to ask about their
procedures and the cost. The telephone number for Nevada Legal News is 382-2747
and the telephone number for both the Review-Journal and the Sun is 383-0383.
NOTE: IF YOU BELIEVE THAT THE PUBLICATION OF THE NOTICE OF
PETITION WILL PUT YOUR SAFETY AT RISK, YOU MAY ASK THE COURT TO
ALLOW YOU TO PROCEED WITHOUT THE PUBLICATION. PLEASE ASK A
SELF-HELP CENTER REPRESENTATIVE FOR ASSISTANCE.
VI.
STEP 5: THE COURT’S REVIEW OF THE PETITION
A.
There are two way to ask the judge to review you Petition:
•
Request for Summary Disposition
•
“Prove-Up” Hearing
For either way, you must wait at least 11 days after the last day your Notice was
published before you can ask the judge to review your Petition.
B.
REQUEST FOR SUMMARY DISPOSITION:
NOTE: SOME DEPARTMENTS DO NOT ALLOW A PETITION FOR
CHANGE OF NAME TO BE REVIEWED BY THE SUMMARY
DISPOSITION PROCESS. YOU SHOULD CALL THE LAW CLERK OF
THE DEPARTMENT YOUR CASE IS ASSIGNED TO AND ASK
WHETHER THAT DEPARTMENT ALLOWS SUMMARY DISPOSITIONS
FOR NAME CHANGES.
1. You will need to complete the following documents and make at least two
copies of each document:
©Clark County Family Law Self-Help Center
August 29, 2003
ALL RIGHTS RESERVED
minor\ namechmi.9in (#7)
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14
•
Request for Summary Disposition
•
Affidavit of Petitioner
2. You need to use a two-hole punch on the top of each original document
and also stamp or write “original” on each original document in between
the two holes. The Self-Help Center has a two-hole punch and a stamp
that you can use.
3. Take the completed Request for Summary Disposition and Affidavit of
Petitioner to the Clerks Office. You should also bring copies of your other
documents with you because you will make a package for the judge’s staff
to review while you are at the courthouse (see No. 5 below).
4. Go to the filing counter at the Clerks Office. The Clerk will file the
original Request for Summary Disposition and the original Affidavit of
Petitioner. He/she will return the file stamped copies to you.
5. Go somewhere where you can put your documents together. You will
need to make a package for the judge’s office to review. That package
needs to have the following documents:
©Clark County Family Law Self-Help Center
August 29, 2003
ALL RIGHTS RESERVED
•
One file-stamped copy of the Petition for Change of Name
•
One file-stamped copy of the Notice of Petition for Change of
Name
•
One file-stamped Order Appointing Guardian Ad Litem (if
required)
•
One file-stamped Consent to Change of Name (if required)
•
One file-stamped copy of the Affidavit of Publication (Unless
requirement is waived by the Court. In that case, include the Order
waiving publication.)
minor\ namechmi.9in (#7)
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15
•
One file-stamped copy of the Affidavit of Petitioner
•
The original Order Changing Name and at least three copies of the
Order
6. Next, take the elevator to the third floor of the courthouse. Go to the
reception area by “chambers.” You will see brown boxes against the wall.
Each box is marked with a department letter. Put the judge’s package into
the box belonging to that department.
7. The judge’s staff will review your paperwork. If it is approved, the judge
will sign the Order. If you need to make some corrections, the staff will
put a note on your papers to tell you how to correct them. It usually takes
between one-to-two weeks from the time that you give your papers to the
department until the staff has reviewed them.
8. The Court does not mail paperwork back to you. After one week, you can
call the Clerks Office at 455-2590 or go the Clerks Office filing counter to
see if your paperwork is ready to be picked up. Tell the Clerk that you are
in “Proper Person” so he/she knows where to look for your paperwork. If
the paperwork is not in the Clerk’s Office after two weeks, you may call
the judge’s office to make sure that they have received your paperwork.
9. If the judge signed your Order, the Clerks Office will automatically file
the Order for you. If your paperwork needs correction, you will need to
follow the instructions from the judge’s office and go through steps 5
through 8 again after you have completed and filed the corrected
document.
10. When you receive your Order from the Clerks Office, you should ask the
Clerk to make at least one certified copy of the Order. It is faster and
cheaper to get certified copies at the time that you pick up your Order than
if you have to order them later. There is a $3.00 fee per certified copy if
you have copies of the Order with you. If the Clerks Office makes the
copies, there is an additional charge of $1.00 per page.
©Clark County Family Law Self-Help Center
August 29, 2003
ALL RIGHTS RESERVED
minor\ namechmi.9in (#7)
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16
11. If your child was born in Nevada, mail a certified copy of the Order along
with a cover letter and a personal check or money order for $20.00 to:
Department of Vital Statistics
505 E. King St., Room 102
Carson City, NV 89701-4749
The letter needs to have your child’s name, mailing address, and the city
where he/she was born. The department will mail one certified copy of
your child’s new birth certificate to you at the address you put in your
cover letter. If you want more than one copy, send an additional $11.00
for each additional birth certificate.
Note: If your child was not born in Nevada, you should
call the Department of Vital Statistics in the state he/she
was born to ask what needs to be done to change the birth
certificate. The Self-Help Center has a list of telephone
numbers for these departments.
C.
THE PROVE-UP HEARING:
1. A “Prove-Up” hearing is a short hearing before the judge when a case is
ready for the judge to sign the Order.
The advantages to a “Prove-Up” are:
•
You do not have to do any extra paperwork (a Request for
Summary Disposition, an Affidavit of Petitioner, etc.);
•
The judge will usually sign the Order while you wait;
•
If you have your hearing between 8:00 a.m. and 5:00 p.m.,
you can take your Order to the Clerks Office after the
hearing. The Clerk will file it and make certified copies for
you while you wait.
The disadvantages to a “Prove-Up” are:
©Clark County Family Law Self-Help Center
August 29, 2003
ALL RIGHTS RESERVED
minor\ namechmi.9in (#7)
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Please call the Self-Help Center to confirm most current version.
17
•
You have to come to Court for a hearing;
•
If your hearing is after 5:00 p.m., either you or a friend will
need to bring your Order to the Clerks Office during
business hours so that it can be filed and you can receive
certified copies of the Order
2. If you decide to do a “Prove-Up” hearing, you will need to do the
following before the hearing:
•
Make sure the Affidavit of Publication or the order waiving
the publication has been filed.
•
Schedule the hearing. Go to the Clerks Office. Go to the
“Master Calendar” window. Ask the Clerk for a “Setting
Slip.” The days that are available for the hearing depend
on which judge your case has been assigned to. Please ask
the Clerk which days and times are available.
•
Call the law clerk for the department your case has been
assigned to and ask whether or not you child(ren) need to
be at the hearing.
3. On the day of the hearing, you will need to:
•
Be on time. “Prove-Up hearings go very fast. If you are late, you
may miss you hearing.
•
Dress as if you were going to a job interview.
•
Bring the following to the hearing:
9 Your Order for Change of Name
9 You (and your child(ren), if required by the judge)
©Clark County Family Law Self-Help Center
August 29, 2003
ALL RIGHTS RESERVED
minor\ namechmi.9in (#7)
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Please call the Self-Help Center to confirm most current version.
18
9 Extra copies of your documents (in case there is not enough
time for the original documents to be placed into the
Court’s file by the Clerks Office).
9 Extra money for certified copies of your Order, if you want
certified copies. If is faster and cheaper to get certified
copies at the time that you file the Order than if you have to
order them later. The fee is $3.00 per certified copy if you
have copies of the Order with you. If the Clerks Office
makes the copies, there is an additional charge of $1.00 per
page.
4. After your hearing, you will need to:
•
Take your original Order and the copies of the Order to the filing
counter at the Clerk’s Office and file your Order.
•
If your child was born in Nevada, mail a certified copy of the
Order, a personal check or money order for $20.00, and a cover
letter to:
Office of Vital Statistics
4150 Technology Way, Suite 104
Carson City, NV 89706
The letters need to have your name, mailing address, and the date
and city where your child was born. The department will mail one
certified copy of your child’s new birth certificate to you at the
address you put in your cover letter. If you want more than one
copy, send an additional $13.00 for each additional birth
certificate. For additional questions you can contact the Office at
(775) 684-4242.
-- Note: If your child was not born in Nevada, you should call the
Department of Vital Statistics in the state your child was born to
ask what needs to be done to change the birth certificate. The SelfHelp Center has a list of telephone numbers for these departments.
©Clark County Family Law Self-Help Center
August 29, 2003
ALL RIGHTS RESERVED
minor\ namechmi.9in (#7)
Use only most current version
Please call the Self-Help Center to confirm most current version.
These forms can be filled out online. To
begin, left click on the first line. In order to
move to the next line, hit the "Tab" key.
1
2
PCON
(Your name)
3
(Address)
____________________________
4
5
(Telephone)
In Proper Person
6
7
DISTRICT COURT
8
CLARK COUNTY, NEVADA
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In the Matter of the
Application of:
)
CASE NO.:
)
)
DEPT. NO.:
_______________________________
)
)
)
for Change of Name of the Minor Children )
)
______________________________
)
(First child’s name)
)
)
and
)
)
_____________________________
)
(Second child’s name)
)
______________________________)
PETITION FOR CHANGE OF NAME
FOR MINOR CHILDREN
_______________
_______________
COMES NOW, Petitioner _________________________________ for [ ] his/ [ ] her petition
to change the name(s) of [ ] his/ [ ] her minor child(ren), respectfully shows:
1.
That [
] he/ [
] she is the natural [
] mother/ [
] father of
_____________________________________, born on __________________, in (city and
state)_________________________________; and ____________________________________, born
on ___________________ in (city and state)________________________________.
26
27
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© Clark County Family Law Self-Help Center
November 8, 2001
ALL RIGHTS RESERVED
NAMECHMI.4PE (#7)
1
Use only most current version
Please call the Self-Help Center to confirm most current version.
1
2.
That Petitioner ____________________________________ has resided in Clark County,
2
Nevada since ____________________ and intends to make Clark County [ ] his/ [ ] her home for at
3
least an indefinite period of time. ________________________________ has resided in Clark County,
4
Nevada since _________________________. ____________________________________ has resided
5
in Clark County, Nevada since _____________________.
6
3.
That, if necessary, Petitioner _____________________________________ will submit
7
paperwork to this Court requesting that [ ] he/ [ ] she be appointed as the child(ren)’s Guardian Ad
8
Litem.
9
10
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4.
That Petitioner would like to change _______________________________________’s
name to _________________________________________________.
5.
That Petitioner would like to change _____________________________________’s
name to _________________________________________________.
6.
That Petitioner wishes to change the child(ren)’s name(s) because___________________
14
________________________________________________________________________________
15
_________________________________________________________________________________.
16
7.
That neither Petitioner nor the child(ren) have been convicted of a felony.
17
8.
That Petitioner is not changing the child(ren)’s name(s) in order to defraud creditors or
18
for some other fraudulent reason.
19
WHEREFORE, Petitioner prays for the following:
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1.
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That
the
above-entitled
Court
enter
its
Order changing
__________________________________’s name to_____________________________________.
2.
That the above-entitled Court enter its Order changing _________________________’s
name to ___________________________________________________.
3.
That the above-entitled Court enter an order for such other and further relief as the Court
shall deem just and proper.
26
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© Clark County Family Law Self-Help Center
November 8, 2002
ALL RIGHTS RESERVED
NAMECHMI.4PE (#7)
2
Use only most current version
Please call the Self-Help Center to confirm most current version.
1
Respectfully Submitted:
2
(Your signature)
3
__________________________________
4
__________________________________
5
__________________________________
6
In Proper Person
7
8
VERIFICATION
9
STATE OF NEVADA
10
COUNTY OF CLARK
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12
)
) ss:
)
__________________________________ , under penalties of perjury, being first duly
sworn, deposes and says:
13
That I am the Petitioner in the above-entitled action; that I have read the foregoing Petition
14
for Change of Name and know the contents thereof; that the same is true of my own knowledge,
15
except for those matters therein contained stated upon information and belief, and as to those
16
matters, I believe them to be true.
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DATED this _____ day of ________________, _________.
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By:
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(Your signature)__________________________________
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SUBSCRIBED and SWORN to before
me this ______ day of
(month)___________, (year)______.
__________________________
NOTARY PUBLIC
///
© Clark County Family Law Self-Help Center
November 8, 2002
ALL RIGHTS RESERVED
NAMECHMI.4PE (#7)
3
Use only most current version
Please call the Self-Help Center to confirm most current version.
1
ACKNOWLEDGMENT
2
STATE OF NEVADA
3
COUNTY OF CLARK
)
)ss:
)
4
On this _______ day of ____________, ________, before me, the undersigned Notary Public
5
in and for the said County and State, personally appeared _________________________________,
6
known to me to be the person described in and who executed the foregoing Petition for Change of
7
Name, and who acknowledged to me that [ ] he/ [ ] she did so freely and voluntarily and for the
8
uses and purposes therein mentioned.
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WITNESS my hand and official seal.
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___________________________________
NOTARY PUBLIC
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© Clark County Family Law Self-Help Center
November 8, 2002
ALL RIGHTS RESERVED
NAMECHMI.4PE (#7)
4
Use only most current version
Please call the Self-Help Center to confirm most current version.
1
2
3
4
NOTC
(Your name)
(Address)
(Telephone)
5
In Proper Person
6
DISTRICT COURT
7
CLARK COUNTY, NEVADA
8
9
DISTRICT COURT
10
CLARK COUNTY, NEVADA
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In the Matter of the
Application of:
)
)
)
_______________________________
)
(Your name)
)
)
for Change of Name of the Minor Children )
)
______________________________
)
(First child’s name)
)
)
and
)
)
_____________________________
)
(Second child’s name)
)
______________________________)
CASE NO.:
_______________
DEPT. NO.:
_______________
21
NOTICE OF PETITION FOR CHANGE OF NAME
22
NOTICE IS HEREBY GIVEN that Petitioner, the natural (check one) [ ] mother/
23
[ ] father of ________________________________________________ filed a petition on the
24
_______ day of (month) _____________, (year) ______ addressed to the above-entitled Court
25
praying that said Court enter its Order changing the child(ren)’s legal name(s) from
26
__________________________ to _________________________ and from ___________________
27
28
© Clark County Family Law Self-Help Center
January 2, 2001
ALL RIGHTS RESERVED
1
Namechmi.3no (#7)
Use only most current version
Please call the Self-Help Center to confirm most current version.
1
to____________________________.
2
NOTICE IS FURTHER GIVEN that any person objecting to the changing of the minor
3
child(ren)’s name(s) as noted above shall file written objection with the above-entitled Court within
4
ten(10) days after the date of the last publication of this Notice.
5
DATED this (day) ______ day of (month) _______________, (year) _______.
6
By:
7
(Your signature)
___________________________________
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© Clark County Family Law Self-Help Center
January 2, 2001
ALL RIGHTS RESERVED
2
Namechmi.3no (#7)
Use only most current version
Please call the Self-Help Center to confirm most current version.
1
AFPT
2
3
4
5
In Proper Person
6
DISTRICT COURT
7
CLARK COUNTY, NEVADA
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9
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In the Matter of the
Application of:
)
)
)
_______________________________
)
)
)
for Change of Name of the Minor Children )
)
______________________________
)
(First child’s name)
)
)
and
)
)
_____________________________
)
(Second child’s name)
)
______________________________)
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CASE NO.:
_______________
DEPT. NO.:
_______________
AFFIDAVIT OF PETITIONER
STATE OF NEVADA
COUNTY OF CLARK
1.
)
) ss:
)
I, _______________________________, Petitioner, do solemnly swear to testify
herein to the truth, the whole truth and nothing but the truth.
2.
That I am the Petitioner in the above-entitled case.
3.
That I live at _________________________________________________________,
________________________, Nevada, (zip code) _____________.
© Clark County Family Law Self-Help Center
January 2, 2001
ALL RIGHTS RESERVED
Namechmi.3af (#7)
1
Use only most current version
Please call the Self-Help Center to confirm most current version.
1
4.
That I first moved to Clark County, Nevada on _________________________. It is
2
my intention to live in Clark County for the foreseeable future. The children in this case are also
3
residents of Clark County, Nevada.
4
5
5.
allegations in the Petition are true and correct to the best of my knowledge.
6
7
6.
That I request that the Court change my child’s name from _____________________
to ________________________________________.
8
9
That I have read the Petition for Change of Name in this case and can testify that the
7.
That I request that the Court change my child’s name from
______________________________________ to ______________________________________.
10
9.
That neither I nor the children in this case have been convicted of a felony.
11
10.
That I am not changing my children’s names to avoid creditors or to commit a fraud.
12
Dated this _____ day of ____________, _____.
13
(Your signature)
14
15
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SUBSCRIBED and SWORN to before
me this ______ day of
________________, ______.
____________________________
NOTARY PUBLIC
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///
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© Clark County Family Law Self-Help Center
January 2, 2001
ALL RIGHTS RESERVED
Namechmi.3af (#7)
2
Use only most current version
Please call the Self-Help Center to confirm most current version.
1
2
3
4
RSDN
(Your name)
(Address) ___________________________
(Telephone)
In Proper Person
5
6
DISTRICT COURT
7
CLARK COUNTY, NEVADA
8
9
10
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In the Matter of the
Application of:
)
)
)
_______________________________
)
(Your name)
)
)
for Change of Name of the Minor Children )
)
______________________________
)
(First child’s name)
)
)
and
)
)
_____________________________
)
(Second child’s name)
)
______________________________)
CASE NO.:
_______________
DEPT. NO.:
_______________
17
18
REQUEST FOR SUMMARY DISPOSITION OF
CHANGE OF NAME
19
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COMES NOW, Petitioner ___________________________ and request(s) this Court for a
summary disposition for change of name(s) without a hearing.
22
(Your signature)
23
24
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© Clark County Family Law Self-Help Center
January 2, 2001
ALL RIGHTS RESERVED
Respectfully Submitted:
________________________________
________________________________
________________________________
________________________________
Petitioner in Proper Person
Namechmi.3re (#7)
1
Use only most current version
Please call the Self-Help Center to confirm most current version.
Use this Order if you want the Department of
Vital Statistics to issue a birth certificate
containing only the child's NEW name.
1
2
ORDR
(Your name)
3
(Address)
___________________________
4
5
(Telephone)
In Proper Person
6
7
DISTRICT COURT
8
CLARK COUNTY, NEVADA
9
10
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17
In the Matter of the
Application of:
)
)
)
_______________________________
)
)
)
for Change of Name of the Minor Children )
)
______________________________
)
(First child’s name)
)
)
and
)
)
_____________________________
)
(Second child’s name)
)
______________________________)
18
CASE NO.:
_______________
DEPT. NO.:
_______________
19
ORDER FOR CHANGE OF NAME
This matter having come on for [ ] hearing/ [ ] summary disposition in the Family Division
20
of the Eighth Judicial District Court, County of Clark, and the Court being fully advised in the premises,
21
both as to the subject matter as well as the party thereto, and that jurisdiction is proper in Nevada, and
22
good cause appearing therefore;
23
IT
IS
HEREBY
ORDERED,
ADJUDGED
AND
DECREED
that
24
_______________________________________, born on __________________________, in (city and
25
state)_________________________, name be changed to __________________________________.
26
///
27
© The Clark County Family Law Self-Help Center
28
October 10, 2001
ALL RIGHTS RESERVED
Namechmi.4or (#7)
1
Use only most current version
Please call the Self-Help Center to confirm most current version.
1
IT
IS
FURTHER
ORDERED,
ADJUDGED
AND
DECREED
that
2
________________________________________, born _____________________, in (city and
3
state)__________________, name be changed to ________________________________________.
4
IT IS FURTHER ORDERED, ADJUDGED AND DECREED that the Department of Vital
5
Statistics shall issue new birth certificate(s) for the minor child(ren) with the name(s) of (new names)
6
________________________________________________________________________________.
7
DATED this ____ day of __________________, ____________.
8
9
________________________________
DISTRICT COURT JUDGE
10
11
Respectfully submitted:
12
(Your signature)
_________________________________
13
_________________________________
14
_________________________________
15
_________________________________
16
_________________________________
Petitioner In Proper Person
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///
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© The Clark County Family Law Self-Help Center
October 10, 2001
ALL RIGHTS RESERVED
Namechmi.4or (#7)
2
Use only most current version
Please call the Self-Help Center to confirm most current version.
Use this Order if you want the Department of Vital
Statistics to issue a birth certificate containing
your child's new name as an "AKA."
1
OCON
2
3
__________________________
4
5
In Proper Person
6
7
DISTRICT COURT
8
CLARK COUNTY, NEVADA
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In the Matter of the
Application of:
)
)
)
_______________________________
)
)
)
for Change of Name of the Minor Children )
)
______________________________
)
)
)
and
)
)
_____________________________
)
)
______________________________)
CASE NO.:
_______________
DEPT. NO.:
_______________
18
19
ORDER FOR CHANGE OF NAME
This matter having come on for [ ] hearing/ [ ] summary disposition in the Family
20
21
Division of the Eighth Judicial District Court, County of Clark; and the Court being fully advised in
22
the premises, both as to subject matter as well as the party thereto, and that jurisdiction is proper in
23
Nevada, and good cause appearing therefore;
24
///
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///
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///
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© Clark County Family Law Self-Help Center
28
October 10, 2001
ALL RIGHTS RESERVED
Namechmi.4ak (#7)
1
Use only most current version
Please call the Self-Help Center to confirm most current version.
1
IT IS HEREBY ORDERED, ADJUDGED AND DECREED that ___________________,
2
born on ________________________, in __________________________, name be changed to
3
_______________________________________.
4
IT IS FURTHER ORDERED, ADJUDGED AND DECREED that __________________,
5
born on _______________________________, in ________________________, name be changed to
6
_______________________________________.
7
8
DATED this ____ day of __________, _______.
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____________________________________
DISTRICT COURT JUDGE
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Respectfully submitted:
(Your signature)
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///
_________________________________
_________________________________
_________________________________
_________________________________
_________________________________
Petitioner In Proper Person
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© Clark County Family Law Self-Help Center
October 10, 2001
ALL RIGHTS RESERVED
Namechmi.4ak (#7)
2
Use only most current version
Please call the Self-Help Center to confirm most current version.
1
CONS
2
(Your name) ___________________________
3
(Address)
4
5
___________________________
___________________________
(Telephone)
6
___________________________
In Proper Person
7
DISTRICT COURT
8
CLARK COUNTY, NEVADA
9
10
11
In the Matter of the
Application of:
12
___________________________________
(Your name)
13
for Change of Name of the Minor Children
14
___________________________________
(First child’s name)
15
17
and
___________________________________
(Second child’s name)
18
___________________________________
16
21
22
23
CASE NO:
________________________
DEPT. NO.
________________________
CONSENT TO NAME CHANGE
19
20
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
I, (consenting parent’s name) _________________________________, the (check one)
mother/
father of the above-referenced minor child(ren), do hereby give my full and free
consent to change (first child’s name) ______________________________________’s name to
__________________________________________. I also give my full and free consent to
24
change (second child’s name or “N/A”)_________________________________’s name to
25
 Clark County Family Law Self-Help Center
August 28, 2003
ALL RIGHTS RESERVED
1
minor\namechmi.4co (#7)
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1
__________________________________________. I request the relief requested in the Petition
2
for Change of Name on file be granted.
3
DATED this _______ day of (month) _______________, (year) __________.
4
_____________________________________
(Consenting parent’s signature)
5
6
7
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9
SUBSCRIBED and SWORN to before
me this ______ day of
(month) ___________, (year) ________.
_________________________________
NOTARY PUBLIC
10
11
ATTEST:
12
________________________________
(First witness’ signature)
13
14
_________________________________
(Second witness’ signature)
15
16
17
18
STATE OF NEVADA
)
)
COUNTY OF Clark County )
ss:
19
The undersigned (first witness’ name) ________________________________ and
20
(second witness’ name) ____________________________, being duly sworn, under oath,
21
depose and say that:
22
We saw (name of consenting parent) ______________________________ sign the
23
attached Consent to Name Change; at the time the Consent to Name Change was signed by
24
(check one)
25
him/
her, it contained the proposed new name(s) for the minor child(ren); we
thereafter subscribed the same as witnesses in the presence of (consenting parent’s name)
 Clark County Family Law Self-Help Center
August 28, 2003
ALL RIGHTS RESERVED
2
minor\namechmi.4co (#7)
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1
_______________________________ and in the presence of each other; at the time that
2
(consenting parent’s name) ____________________________ signed the Consent to Name
3
Change (check one)
he/
she acknowledged to us that (check one)
he/
she was, and
4
appeared to us to be, in full possession of (check one)
his/
her faculties and not under the
5
influence of any drug, or subject to any duress, fear, menace, compulsion or undue influence
6
7
whatsoever; and we make this affidavit at (check one)
his/
her request.
8
(First witness’ signature)
______________________________
9
(First witness’ name)
______________________________
10
11
(Second witness’ signature) ______________________________
12
(Second witness’ name)
______________________________
13
14
15
SUBSCRIBED and SWORN to before
me this ______ day of
(month) ___________, (year) ________.
16
17
_________________________________
NOTARY PUBLIC
18
///
19
///
20
///
21
///
22
///
23
///
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///
25
///
///
 Clark County Family Law Self-Help Center
August 28, 2003
ALL RIGHTS RESERVED
3
minor\namechmi.4co (#7)
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Please call the Self-Help Center to confirm most current version.
1
2
3
4
GAL
(Your name) ___________________________
(Address)
___________________________
___________________________
(Telephone) ___________________________
In Proper Person
5
DISTRICT COURT
6
CLARK COUNTY, NEVADA
7
8
9
10
11
12
13
14
15
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17
In the Matter of the
Application of:
)
)
CASE NO: ________________________
)
___________________________________ )
DEPT. NO. ________________________
(Your name)
)
)
for Change of Name of the Minor Children )
)
___________________________________ )
(First child’s name)
)
)
and
)
___________________________________ )
(Second child’s name)
)
)
___________________________________ )
APPLICATION FOR APPOINTMENT AS GUARDIAN AD LITEM
COMES NOW, Applicants, (your name) _________________________________, (first
18
child’s name) ___________________________________ and (second child’s name – if no
19
second child, write “N/A”) ____________________________________, pursuant to NRS
20
12.050, for their motion to have (your name) _________________________________________
21
be appointed as Guardian Ad Litem, respectfully show:
22
23
1.
That Applicant (first child’s name) ___________________________________
is ___________ years old and was born on (date) _________________.
24
2.
That Applicant (second child’s name or “N/A”) ___________________________
25
_____________________ is ____________ years old and was born on (date) _______________.
 Clark County Family Law Self-Help Center
August 28, 2003
ALL RIGHTS RESERVED
1
minor\namechmi.514 (#7)
Use only most current version
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3.
1
2
3
father/
That (your name) _______________________________ is the (check one)
mother of the above-named child(ren), is a competent person, a resident of Clark
County, Nevada, at least 18 years old, and is willing to act as Guardian Ad Litem to appear and
4
prosecute said action for the name change on behalf of the minor applicants.
5
4.
That no general guardian, conservator, or other fiduciary has ever been appointed
6
7
on behalf of the child(ren) and the child(ren) is/are not ward(s) of any court.
8
WHEREFORE, Applicants pray to have (your name) ____________________________
9
be appointed as the Guardian Ad Litem for (first child’s name) __________________________
10
__________________ and (second child’s name or “N/A”) _____________________________
11
____________________________ to appear and prosecute an action for a change of name on
12
their behalf and to act for them for the purpose of this action.
13
14
DATED this ______ day of (month) ____________________, (year) ____________.
16
Respectfully submitted:
(Your signature)
(Your name)
(Address)
17
(Telephone)
15
_____________________________
_____________________________
_____________________________
_____________________________
_____________________________
In Proper Person
18
19
20
21
22
23
(First child’s signature)
(First child’s name)
(Address)
(Telephone)
Second child’s signature)
(Second child’s name)
(Address)
24
(Telephone)
25
 Clark County Family Law Self-Help Center
August 28, 2003
ALL RIGHTS RESERVED
_____________________________
_____________________________
_____________________________
_____________________________
_____________________________
In Proper Person
_____________________________
_____________________________
_____________________________
_____________________________
_____________________________
In Proper Person
2
minor\namechmi.514 (#7)
Use only most current version
Please call the Self-Help Center to confirm most current version.
1
VERIFICATION
2
STATE OF NEVADA
3
4
5
6
)
) ss:
COUNTY OF Clark County)
(Your name) _________________________________, under penalties of perjury, being
first duly sworn, deposes and says:
That I am the Petitioner in the above-entitled action; that I have read the foregoing
7
Application for Appointment as Guardian Ad Litem and know the contents thereof; that the same
8
is true of my own knowledge, except for those matters therein contained stated upon information
9
10
11
and belief, and as to those matters I believe them to be true.
DATED this ______ day of (month) ______________, (year) ____________.
By:
12
(Your signature)
(Your name)
13
________________________
________________________
14
15
SUBSCRIBED and SWORN to before
me this ______ day of
(month) ___________, (year) ________.
16
17
18
19
20
21
_________________________________
NOTARY PUBLIC
ACKNOWLEDGMENT
STATE OF NEVADA
COUNTY OF CLARK
)
) ss:
)
On this _____ day of (month) _____________, ___________, before me, the
22
undersigned Notary Public in and for the said County and State, personally appeared (your
23
name) _____________________________, known to me to be the person described in and who
24
25
executed the foregoing Application for Appointment as Guardian Ad Litem, and who
 Clark County Family Law Self-Help Center
August 28, 2003
ALL RIGHTS RESERVED
3
minor\namechmi.514 (#7)
Use only most current version
Please call the Self-Help Center to confirm most current version.
1
acknowledged to me that (check one)
2
and purposes therein mentioned.
3
__________________________________
NOTARY PUBLIC
5
6
VERIFICATION
STATE OF NEVADA
7
9
10
she did so freely and voluntarily and for the uses
WITNESS my hand and official seal.
4
8
he/
)
) ss:
COUNTY OF Clark County)
(First child’s name) _________________________________, under penalties of perjury,
being first duly sworn, deposes and says:
11
That I am the Applicant in the above-entitled action; that I have read the foregoing
12
Application for Appointment as Guardian Ad Litem and know the contents thereof; that the same
13
14
15
16
is true of my own knowledge, except for those matters therein contained stated upon information
and belief, and as to those matters I believe them to be true.
DATED this ______ day of (month) ______________, (year) ____________.
By:
(First child’s signature)
(First child’s name)
17
18
19
20
21
22
________________________
________________________
SUBSCRIBED and SWORN to before
me this ______ day of
(month) ___________, (year) ________.
_________________________________
NOTARY PUBLIC
23
24
25
 Clark County Family Law Self-Help Center
August 28, 2003
ALL RIGHTS RESERVED
4
minor\namechmi.514 (#7)
Use only most current version
Please call the Self-Help Center to confirm most current version.
1
ACKNOWLEDGMENT
2
STATE OF NEVADA
3
COUNTY OF CLARK
)
) ss:
)
4
On this _____ day of (month) _____________, ___________, before me, the
5
6
undersigned Notary Public in and for the said County and State, personally appeared (first
7
child’s name) _____________________________, known to me to be the person described in
8
and who executed the foregoing Application for Appointment as Guardian Ad Litem, and who
9
acknowledged to me that (check one)
10
he/
she did so freely and voluntarily and for the uses
and purposes therein mentioned.
11
WITNESS my hand and official seal.
12
__________________________________
NOTARY PUBLIC
13
14
VERIFICATION
15
16
17
STATE OF NEVADA
)
) ss:
COUNTY OF Clark County)
18
(Second child’s name) _________________________________, under penalties of
19
perjury, being first duly sworn, deposes and says:
20
That I am the Applicant in the above-entitled action; that I have read the foregoing
21
22
23
Application for Appointment as Guardian Ad Litem and know the contents thereof; that the same
is true of my own knowledge, except for those matters therein contained stated upon information
24
///
25
///
 Clark County Family Law Self-Help Center
August 28, 2003
ALL RIGHTS RESERVED
5
minor\namechmi.514 (#7)
Use only most current version
Please call the Self-Help Center to confirm most current version.
1
and belief, and as to those matters I believe them to be true.
2
DATED this ______ day of (month) ______________, (year) ____________.
3
By:
4
(Second child’s signature)
(Second child’s name)
5
6
7
8
9
________________________
________________________
SUBSCRIBED and SWORN to before
me this ______ day of
(month) ___________, (year) ________.
_________________________________
NOTARY PUBLIC
ACKNOWLEDGMENT
10
STATE OF NEVADA
11
COUNTY OF CLARK
)
) ss:
)
12
13
On this _____ day of (month) _____________, ___________, before me, the
14
undersigned Notary Public in and for the said County and State, personally appeared (second
15
child’s name) _____________________________, known to me to be the person described in
16
and who executed the foregoing Application for Appointment as Guardian Ad Litem, and who
17
acknowledged to me that (check one)
18
he/
she did so freely and voluntarily and for the uses
and purposes therein mentioned.
19
WITNESS my hand and official seal.
20
__________________________________
NOTARY PUBLIC
21
22
23
///
24
///
25
///
 Clark County Family Law Self-Help Center
August 28, 2003
ALL RIGHTS RESERVED
6
minor\namechmi.514 (#7)
Use only most current version
Please call the Self-Help Center to confirm most current version.
1
2
3
4
GAL
(Your name) ___________________________
(Address)
___________________________
___________________________
(Telephone) ___________________________
In Proper Person
5
DISTRICT COURT
6
CLARK COUNTY, NEVADA
7
8
9
10
11
12
13
14
15
16
17
In the Matter of the
Application of:
)
)
CASE NO: ________________________
)
___________________________________ )
DEPT. NO. ________________________
(Your name)
)
)
for Change of Name of the Minor Children )
)
___________________________________ )
(First child’s name)
)
)
and
)
___________________________________ )
(Second child’s name)
)
)
___________________________________ )
APPLICATION FOR APPOINTMENT AS GUARDIAN AD LITEM
COMES NOW, Petitioner, (your name) _______________________________, (check
18
one) Q mother/ Q father of (child(ren)’s current name(s)) __________________________
19
_________________________________________________, pursuant to NRS 12.050, for
20
(check one) Q his/ Q her motion to be appointed as Guardian Ad Litem for the child(ren),
21
respectfully shows:
22
1.
That Petitioner is asking to be appointed Guardian Ad Litem for (first child’s
23
current name) _____________________________________, a minor, age __________, born on
24
(date) _________________.
25
 Clark County Family Law Self-Help Center
August 28, 2003
ALL RIGHTS RESERVED
1
minor\namechmi.4gu (#7)
Use only most current version
Please call the Self-Help Center to confirm most current version.
1
2
3
4
2.
That Petitioner is also asking to be appointed Guardian Ad Litem for (second
child’s name or “N/A”) ______________________________________, a minor, age ________,
born on (date) ____________________.
3.
That Petitioner is a competent person, is a resident of Clark County, Nevada, is at
5
least 18 years old, and is willing to act as Guardian Ad Litem to appear and prosecute said action
6
for the name change on behalf of (check one) Q his/ Q her child(ren).
7
4.
That no general guardian, conservator, or other fiduciary has ever been appointed
8
9
on behalf of the child(ren) and the child(ren) is/are not ward(s) of any court.
10
WHEREFORE, Petitioner prays to be appointed as the Guardian Ad Litem for (first
11
child’s name) ________________________________ and (second child’s name or “N/A”)
12
_______________________________, to appear and prosecute an action for a change of name
13
on their behalf and to act for them for the purpose of this action.
14
15
16
17
18
DATED this ______ day of (month) ____________________, (year) ____________.
Respectfully submitted:
(Your signature)
_____________________________
(Your name)
_____________________________
(Address)
_____________________________
_____________________________
(Telephone)
_____________________________
In Proper Person
19
VERIFICATION
20
21
STATE OF NEVADA
22
COUNTY OF Clark County)
(Your name) _________________________________, under penalties of perjury, being
23
24
25
)
) ss:
first duly sworn, deposes and says:
That I am the Petitioner in the above-entitled action; that I have read the foregoing
Application for Appointment as Guardian Ad Litem and know the contents thereof; that the same
 Clark County Family Law Self-Help Center
August 28, 2003
ALL RIGHTS RESERVED
2
minor\namechmi.4gu (#7)
Use only most current version
Please call the Self-Help Center to confirm most current version.
1
is true of my own knowledge, except for those matters therein contained stated upon information
2
and belief, and as to those matters I believe them to be true.
3
DATED this ______ day of (month) ______________, (year) ____________.
4
By:
5
(Your signature)
(Your name)
6
7
8
9
10
________________________
________________________
SUBSCRIBED and SWORN to before
me this ______ day of
(month) ___________, (year) ________.
_________________________________
NOTARY PUBLIC
ACKNOWLEDGMENT
11
12
STATE OF NEVADA
13
COUNTY OF CLARK
)
) ss:
)
14
On this _____ day of (month) _____________, ___________, before me, the
15
undersigned Notary Public in and for the said County and State, personally appeared (your
16
17
name) _____________________________, known to me to be the person described in and who
18
executed the foregoing Application for Appointment as Guardian Ad Litem, and who
19
acknowledged to me that (check one) Q he/ Q she did so freely and voluntarily and for the uses
20
and purposes therein mentioned.
WITNESS my hand and official seal.
21
22
__________________________________
NOTARY PUBLIC
23
24
///
25
///
 Clark County Family Law Self-Help Center
August 28, 2003
ALL RIGHTS RESERVED
3
minor\namechmi.4gu (#7)
Use only most current version
Please call the Self-Help Center to confirm most current version.
1
OGAL
2
(Your name) ___________________________
3
(Address)
4
5
6
___________________________
___________________________
(Telephone)
___________________________
In Proper Person
7
DISTRICT COURT
8
CLARK COUNTY, NEVADA
9
10
11
In the Matter of the
Application of:
12
___________________________________
(Your name)
13
for Change of Name of the Minor Children
14
___________________________________
(First child’s name)
15
17
and
___________________________________
(Second child’s name)
18
___________________________________
16
CASE NO:
________________________
DEPT. NO.
________________________
ORDER APPOINTING GUARDIAN AD LITEM
19
20
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
The above-entitled matter having been submitted to this Court for an Order Appointing
21
Guardian Ad Litem, and after reviewing the papers and pleadings on file, and good cause
22
appearing therefore;
IT IS HEREBY ORDERED that Petitioner (your name) _________________________
23
24
25
__________________________ the (check one)
mother/
father of the minor child(ren)
___________________________________________________________ is appointed their
 Clark County Family Law Self-Help Center
August 28, 2003
ALL RIGHTS RESERVED
1
minor\namechmi.4go (#7)
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1
Guardian Ad Litem for the purpose of instituting and prosecuting an action on their behalf to
2
change their names as set forth in the Application for the Appointment asGuardian Ad Litem.
3
DATED this ________ day of _______________, __________.
4
5
____________________________________
DISTRICT COURT JUDGE
6
7
Respectfully submitted:
(Your signature)
_____________________________
8
9
10
(Your name)
_____________________________
(Address)
_____________________________
_____________________________
11
12
(Telephone)
13
///
14
///
15
///
16
///
17
///
18
19
_____________________________
In Proper Person
///
///
20
///
21
///
22
23
///
24
///
25
///
///
 Clark County Family Law Self-Help Center
August 28, 2003
ALL RIGHTS RESERVED
2
minor\namechmi.4go (#7)
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Please call the Self-Help Center to confirm most current version.