KING COUNTY DISTRICT COURT
STATE OF WASHINGTON
East Division, Bellevue Courthouse
In re the Petition of:
________________________________ )
No. _________________________
)
for the Change of Name of:
)
)
PETITION FOR CHANGE OF NAME
________________________________ )
OF A MINOR
A Minor. [First, Middle Last Name] )
Comes now ________________________________________ (legibly print full name) and
First, Middle, Last
________________________________________________(legibly print full name) petitioning
First, Middle, Last
the court for an order changing the name of _________________________________________
First, Middle, Last
(legibly print current name) his, her, their (circle one) son, daughter, ward (circle one), to the
name ________________________________________________________ , and states that:
First, Middle, Last
1. The child is __ years of age and was born on _____________, at _________________.
(date of birth)
(place of birth)
2. Is the child a resident of King County, Washington? Yes
No
3. Is the child required to register as a sex offender? Yes
No
[Failure to provide required notice to the King County Sheriff and Washington
State Patrol is a crime. RCW 9A.44.130(8).]
4. Is the child an offender under the jurisdiction of the Department of Corrections?
Yes
No
[Failure to provide required notice to the DOC is a crime. RCW 4.24.130.]
5. Is/are the petitioner(s) the parent(s) of the child? Yes
No
6. If not the parent(s), is/are the petitioner(s) the child’s legal guardian and have the legal
authority to submit this petition. Yes
No
7. The child’s other parent:
A. Has given consent to this name change and signed the petition. Yes
No
B. Has not given consent to this name change. Yes
No
C. Has not been located and has had no contact with petitioner. Yes
No
Date of last contact with other parent: ____________________________________
Revised 7/2010
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