KING COUNTY DISTRICT COURT
STATE OF WASHINGTON
In re the Petition of:
)
NO. ____________________
)
Current Name: ____________________________ )
PETITION FOR NAME CHANGE
(Individual)
First, Middle, Last
My current legal name is ____________________________________ [legibly print full name].
First, Middle, Last
I am applying for a court order which will change my current name to:
_____________________________________________________ [legibly print full new name],
First, Middle, Last
and I make the following statements under penalty of perjury.
1. Are you currently a resident of King County, Washington? Yes
No
2. Are you required to register as a sex offender? Yes
No
[Petitioner’s failure to provide required notice to the King County Sheriff and
Washington State Patrol is a crime. RCW 9A.44.130(8).]
3. Are you an offender under the jurisdiction of the Department of Corrections?
Yes
No
[Petitioner’s failure to provide required notice to DOC is a crime. RCW 4.24.130.]
4. Have you had a name change prior to this petition? Please explain. (Date, place, reason)
______________________________________________________________________
______________________________________________________________________
5. I request a change of name for the following reason(s). Please explain:
______________________________________________________________________
______________________________________________________________________
6. I declare that this name change petition is not made for any illegal or fraudulent purpose.
7. I declare that my name change will not be detrimental to the interests of anyone else.
I DECLARE UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE
OF WASHINGTON THAT THE FOREGOING STATEMENTS IN THIS PETITION
ARE TRUE AND CORRECT.
Signed at __________________________, Washington, on _______________________.
City
Date
___________________________________
Petitioner’s Signature
Received: ______________________
Petitioner's Street Address
Court Clerk
Petitioner's City, State, Zip
Revised 7/2010