Fillable AOS Self-Represented DISTRICT COURT CLARK COUNTY, NEVADA (Family Law Self Help Center)

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AOS Self-Represented DISTRICT COURT CLARK COUNTY, NEVADA (Family Law Self Help Center)

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© 2017 Family Law Self-Help Center Proof of Service (Child Name Change)
1
AOS
Your Name:
Address:
Telephone:
Email Address:
Self-Represented
DISTRICT COURT
CLARK COUNTY, NEVADA
In the Matter of the Application of:
(1
st
adult) ________________________________
And
(2
nd
adult) ________________________________
write “n/a” above if only 1 adult.
For Change of Name for Themselves and for the
Minor Children:
(1
st
child’s name) ___________________________
And
(2
nd
child’s name) __________________________
CASE NO.: ____________________
DEPT: _____________________
AFFIDAVIT OF SERVICE (Child Name Change)
I, (name of person who served the documents) _________________________________, declare
that:
1. I am not a party to or interested in this action and I am over 18 years of age.
2. Who and What Documents You Served. I served (name of parent you served)
____________________________________ with a copy of the ( check all that apply)
Petition to Change Minor Child(ren)’s Name
Notice of Petition to Change Minor Child(ren)’s Name
Other: _______________________________________________________
THIS FORM MUST BE COMPLETED BY THE PERSON WHO SERVED THE PAPERS ON THE OTHER
PARENT.
The form cannot be electronically signed. Once you complete the form, you must print it out and sign it. Your
original signature must appear on the document that is filed with the court.
© 2017 Family Law Self-Help Center Proof of Service (Child Name Change)
2
3. When You Served. I personally served the documents on (date you served the
documents) (month) ___________________________ (day) _______, 20____ at the
hour of (time) ____:____ a.m. p.m.
4. Where You Served. I personally delivered and left the documents with ( check one)
The Party to the Case. I served the documents on the party at the location
below. (complete the details below)
_________________________________________
Name of Person Served
_________________________________________
Address Where Served
_________________________________________
City, State, Zip Code
A Person Who Lives with the Party. This is a person of suitable age and
discretion who lives with the party. (complete the details below)
_________________________________________
Name of Person Served
_________________________________________
Address Where Served
_________________________________________
City, State, Zip Code
5. I am not a licensed process server; I am a natural person serving legal process without
compensation, not more than three times per year, on behalf of a litigant who is a
natural person, and therefore I am not required to be licensed pursuant to NRS
648.063(2) (2017 Nevada Laws Ch. 126 (A.B. 128)).
I DECLARE UNDER PENALTY OF PERJURY UNDER THE LAW OF THE STATE
OF NEVADA THAT THE FOREGOING IS TRUE AND CORRECT.
DATED (month) ___________________________ (day) _______, 20____.
Server’s Signature:
Server’s Printed Name:
Residential / Business Address:
City, State, Zip:
Server’s Phone Number:
Server’s License/Registration Number:
(if applicable)
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AOS Self-Represented DISTRICT COURT CLARK COUNTY, NEVADA (Family Law Self Help Center)

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Completed 9 February 2021

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