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

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

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© 2017 Family Law Self-Help Center Order for Family Name Change
1
ORDR
Your Name: ________________________
Address: ___________________________
City, State, Zip: _____________________
Phone: ____________________________
Email: ____________________________
Self-Represented Petitioner
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: _____________________
ORDER FOR CHANGE OF NAMES
This Order was submitted ( check one) after a hearing without a hearing before
the above-entitled court, and after a review of the pleadings and papers on file and the testimony
given, if any, and good cause appearing therefore:
IT IS HEREBY ORDERED that the name of the first adult Petitioner, who was born
on (date of birth) ____________________________ in (city) _______________________
(state) ____________________ be legally changed from (first adult’s name)
(old) _____________________ ______________________ _______________________
(first) (middle) (last)
To (new) _____________________ ______________________ ______________________
(first) (middle) (last)
A new birth certificate (☒ check one) shall shall not be issued reflecting the name change.
Page 2 of 3 - Order for Family Name Change
IT IS FURTHER ORDERED that the name of the second adult Co-Petitioner, who
was born on (date of birth) _____________________ in (city) _______________________
(state) ____________________ be legally changed from (second adult’s name)
(old) _____________________ ______________________ _______________________
(first) (middle) (last)
To (new) _____________________ ______________________ ______________________
(first) (middle) (last)
A new birth certificate (☒ check one) shall shall not be issued reflecting the name change.
IT IS FURTHER ORDERED that the name of the first child, who was born on (first
child’s date of birth) ___________________________________ in (city)
_______________________, (state) ____________________ shall be legally changed from
(clearly print the first child’s current, full, legal name)
_____________________ ______________________ _______________________
(first) (middle) (last)
to (clearly print the child’s new name)
_____________________ ______________________ _______________________
(first) (middle) (last)
A new birth certificate (☒ check one) shall shall not be issued reflecting the name change.
Page 3 of 3 - Order for Family Name Change
IT IS FURTHER ORDERED that the name of the second child, who was born on (date
of birth) ____________________________________ in (city) _______________________,
(state) ____________________ be legally changed from (clearly print the second child’s
current, full, legal name)
_____________________ ______________________ _______________________
(first) (middle) (last)
to (clearly print the child’s new name)
_____________________ ______________________ _______________________
(first) (middle) (last)
A new birth certificate (☒ check one) shall shall not be issued reflecting the name change.
DATED this ______ day of _______________________, 20____.
____________________________________
DISTRICT COURT JUDGE
Respectfully Submitted By:
________________________________ ________________________________
(First Parent’s signature) (Second Parent’s signature)
________________________________ _________________________________
(First Parent’s printed name) (Second Parent’s printed name)
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ORDR Self-Represented Petitioner DISTRICT COURT CLARK COUNTY, NEVADA (Family Law Self Help Center)

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Completed 9 February 2021

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