Order Changing Name Of An Adult
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For Clerk’s Use Only
SUPERIOR COURT OF ARIZONA
IN MOHAVE COUNTY
In the Matter of:
______________________________
Case Number: _____________________________
Name of Applicant
ORDER CHANGING NAME OF
AN ADULT
THE COURT FINDS:
1.
This case has come before this Court to change the legal name of the Applicant.
2.
This Court has jurisdiction to change the legal name of the Applicant.
3.
Good cause exists to grant the application for change of legal name.
THE COURT ORDERS:
1.
The name on the Birth Certificate or
the Current Legal Name:
____________________________ __________________________ _________________________
(First)
(Middle)
(Last)
Date of Birth:
____________________ ______________________ ______________________
(Month)
(Day)
(Year)
Place of Birth:
____________________ ______________________ ______________________
(City)
(State)
(Nation)
IS CHANGED TO:
____________________________ __________________________ _________________________
(First)
(Middle)
(Last)
2.
For a person born in the State of Arizona, the Office of Vital Records is ordered to amend the
birth record to reflect the new name as ordered above.
For a person born in a state other than Arizona, to the extent that the agency that maintains birth
records in that state is authorized to honor an order of this Court, that agency is requested or ordered
to amend its birth records to reflect the new name as ordered above.
3.
This Order does not release the Applicant from any obligations incurred or harm any rights of property
or action in any original name.
4.
Other orders: ______________________________________________________________________
DONE IN OPEN COURT:
_____________________________
Date
Judicial Officer
Page 1 of 1
Revised 1/4/2010
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