Petition For Change Of Name Of A Minor Page 2
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28. Has the child ever had a name change prior to this petition? Yes
No
Please explain. (Date, place, reason) _________________________________________
_______________________________________________________________________
9. I/we declare this petition is not made for any illegal or fraudulent purpose.
10. I/we declare this petition will not be detrimental to the interests of anyone else.
11. Any child named in this petition who is age 14 or older joins in the petition and has
signed the petition.
12. Petitioner(s) request a change of name for the following reason(s). Please explain.
____________________________________________________________________
____________________________________________________________________
I DECLARE UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE
STATE OF WASHINGTON THAT THE FOREGOING STATEMENTS IN THIS
PEITION FOR A NAME CHANGE OF A MINOR ARE TRUE AND CORRECT.
Signed at ____________________________, Washington, on ____________________, 20___.
City
Date
____________________________________
___________________________________
Parent/Guardian Signature
Parent/Guardian Signature
____________________________________
____________________________________
Parent/Guardian Printed Name
Parent/Guardian Printed Name
____________________________________
____________________________________
Minor’s Signature (if over 14 years of age)
Minor’s Printed Name
Received: ___________________________
Court Clerk
Petitioner's Street Address
Petitioner's City, State, Zip
Revised 7/2010
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