Name Change Petition (Minor) - Grant County (Page 2 of 2) in pdf

Name Change Petition (Minor) - Grant County Page 2

6. This application is made for the following reason(s):

____________________________________________________________________________________

7. This Petition is not made for any illegal or fraudulent purposes or to defraud any creditors. The change

of name would not be detrimental to the interest of any other person.

The minor is not subject to the jurisdiction of the Washington Department of Corrections.

The minor is subject to the jurisdiction of the Washington State Department of Corrections. I

certify that I provided a copy of this Petition to the Department on . I know I must provide a copy of any

order granting a name change to the Department within five days of its entry by the Court and that failure

to do so is a crime.

The minor is not subject to the sex offender registration laws of the State of Washington.

The minor is subject to the sex offender registration laws of the State of Washington. I certify that I

provided a copy of this Petition to the Yakima County Department on and the Washington State Patrol on

I know I must provide a copy of any order granting a name change to the sheriff of the County where I

reside and to the Washington State Patrol within five days of its entry by the Court and that failure to do

so is a crime.

10. The undersigned declares under penalty of perjury under the laws of the State of Washington

that the foregoing statements are true and correct.

Signed at________________________________ on __________________________________________

[Write in city where you signed this form]

[Write in date you signed this form]

_______________________________________________

[Signature of Parent or Legal Guardian]

Signed at________________________________ on __________________________________________

[Write in city where you signed this form]

[Write in date you signed this form]

_______________________________________________

[Signature of Second Parent or Legal Guardian]

GCDC Name Change Petition (Minor)

January 2011

Name Change Petition (Minor) - Grant County Page 2