© 2017 Family Law Self-Help Center Petition to Change Minor’s Name
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classes, visit www.familylawselfhelpcenter.org or the Family Law Self Help Center at 601 N. Pecos Road. To find
an attorney, call the State Bar of Nevada at (702) 382-0504.
1
PCON
Your Name:
Address:
Telephone:
Email Address:
Self-Represented
DISTRICT COURT
CLARK COUNTY, NEVADA
In the Matter of the Application of:
_
__________________________________
(Parent’s name(s))
For Change of Name of the Minor Children:
_
__________________________________
(First child’s name)
_
__________________________________
and (Second child’s name or “N/A”)
CASE NO.: ____________________
DEPT: _____________________
PETITION TO CHANGE MINOR CHILD(REN)’S NAME
Petitioner(s) respectfully states as follows:
1. Petitioner is the parent of the child(ren) of the above-captioned petition.
2. Parents. The parents of the child(ren) are:
First Parent:
Name: ___________________________
Address: _________________________
City, State, Zip: ___________________
This parent agrees to the name change.
This parent will not agree to the name
change (you must explain why not on
the next page).
Second Parent:
Name: ___________________________
Address: _________________________
City, State, Zip: ___________________
This parent agrees to the name change.
This parent will not agree to the name
change (you must explain why not on
the next page).
Page 2 of 4 - Petition to Change Minor’s Name
3. Consent. If a parent will not agree to the name change, check one of the following to
indicate why:
The parent is deceased.
The parent’s rights were terminated on (date) __________________. A copy of
the court order is attached.
The parent is the father, there is no father is listed on the birth certificate, and the
father is truly unknown.
The parent’s location is unknown.
Other: (explain why the other parent is not signing a consent):
4. First Child. The first child was born on (date of birth) _____________________ in
(city) _______________________, (state) ____________________. The child’s current
legal name is (clearly print the child’s current, full, legal name):
_____________________ ______________________ _______________________
(first) (middle) (last)
The new name requested is: (clearly print the new name you want the child to have)
_____________________ ______________________ _______________________
(first) (middle) (last)
5. Second Child. The second child was born on (date of birth) _____________________
in (city) _______________________, (state) ____________________. The child’s
current legal name is (clearly print the child’s current, full, legal name):
_____________________ ______________________ _______________________
(first) (middle) (last)
The new name requested is: (clearly print the new name you want the child to have)
_____________________ ______________________ _______________________
(first) (middle) (last)
Page 3 of 4 - Petition to Change Minor’s Name
6. Reason. I understand that if I originally agreed to the child’s name as it is now, I must
show that there is clear and compelling evidence that the substantial welfare of the child
necessitates a name change. If I did not originally agree to the child’s name, I understand
that I must show that the name change is in the child’s best interest. The child(ren)’s
name(s) should be changed because (explain why you want to change the names):
7. Residence. Petitioner and the child(ren) have resided in Clark County, Nevada since
(date) __________________ and intend to live in Clark County, Nevada indefinitely.
8. Felony. The minor child(ren) have not been convicted of a felony.
9. Child Consent. Any child age 14 or older will file a separate consent agreeing to the
requested name change.
WHEREFORE, Petitioner prays for an order changing the minor child(ren)’s names as
indicated.
Date: ____________________________ Date: ____________________________
________________________________ ________________________________
(First Parent’s signature) (Second Parent’s signature)
________________________________ _________________________________
(First Parent’s printed name) (Second Parent’s printed name)
Page 4 of 4 - Petition to Change Minor’s Name
FIRST PARENT’S VERIFICATION
STATE OF NEVADA )
)
COUNTY OF CLARK )
(Parent’s name) _________________________________________ being first duly
sworn under penalty of perjury, deposes and says:
I am the Petitioner herein, and I have read the foregoing Petition and know the contents
thereof; that the pleading is true to the best of my own knowledge, except as to those matters
therein stated upon information and belief, and as to those matters, I believe them to be true.
________________________________
(Parent’s signature)
Signed and sworn to (or affirmed) before me on
(date) _____________ by (name) ____________________
Signature of notarial officer
SECOND PARENT’S VERIFICATION
STATE OF NEVADA )
)
COUNTY OF CLARK )
(Parent’s name) ___________________________________________ being first duly
sworn under penalty of perjury, deposes and says:
I am the Petitioner herein, and I have read the foregoing Petition and know the contents
thereof; that the pleading is true to the best of my own knowledge, except as to those matters
therein stated upon information and belief, and as to those matters, I believe them to be true.
________________________________
(Parent’s signature)
Signed and sworn to (or affirmed) before me on
(date) _____________ by (name) ____________________
Signature of notarial officer