Name Change Petition - Arizona

APPLICATION FOR CHANGE OF NAME OF AN ADULT

Before you use this: Arizona's Judicial Branch offers adult application form CVNC11F, and a local Superior Court may prefer its own form. Check the filing court's current forms and instructions before submitting this application.

IN THE SUPERIOR COURT OF THE STATE OF ARIZONA

IN AND FOR THE COUNTY OF [____________________________]

Case No.: [____________________________]

Applicant [CURRENT FULL LEGAL NAME] applies under A.R.S. § 12-601 for a judgment changing Applicant's legal name and states under penalty of perjury:

1. Residence and venue. Applicant resides in [____________________________] County, Arizona, at [STREET ADDRESS, CITY, ZIP]. This is the county of Applicant's residence.

2. Current and requested name. Applicant's current legal name is [CURRENT FULL LEGAL NAME]. Applicant asks to adopt [REQUESTED FULL LEGAL NAME].

3. Reasons. Applicant requests the change for these reasons: [DESCRIBE REASONS].

4. Felony conviction. Applicant ☐ has ☐ has not been convicted of a felony. If yes, identify each conviction, jurisdiction, court, case number, and date: [DETAILS].

5. Pending identity-related charges. Applicant ☐ has ☐ has no pending felony charge in any jurisdiction for an offense under Arizona Title 13, chapter 18, 20, 21, 22, 23, or 27, or another offense involving false statements or misrepresentations about Applicant's identity. If yes, identify the charge, jurisdiction, court, and case number: [DETAILS].

6. Another person's name and prohibited purpose. Applicant ☐ is ☐ is not knowingly changing Applicant's name to that of another individual for the purpose of committing or furthering an offense described in A.R.S. § 12-601(C)(3). If yes, explain: [DETAILS].

7. Applicant's best interest. Applicant makes this application solely for Applicant's best interest. Facts supporting that statement: [DETAILS].

8. Existing obligations and rights. Applicant acknowledges that a change of name will not release Applicant from obligations incurred under the original name or harm rights of property or action held in the original name.

9. Sex-offender registration conviction. Applicant ☐ has ☐ has not been convicted in any state of an offense for which Applicant is required to register as a sex offender. If yes, identify the conviction, jurisdiction, case number, and registration status: [DETAILS].

10. Service on prosecuting agency after conviction. Applicant ☐ has no conviction requiring service under A.R.S. § 12-601(D) ☐ has served a copy of this application on the prosecuting agency of the Arizona county of conviction ☐ has served the prosecuting agency in another state of conviction and the county attorney in this filing county. Identify the agency, date, and method of service, or explain any remaining service: [DETAILS].

11. Notice. Applicant asks the Court to decide whether notice by publication or service on an interested party is proper under A.R.S. § 12-602(A). If the Court orders notice, Applicant will comply and file proof as directed. Persons whose interests may be affected, if known: [NAMES AND RELATIONSHIPS OR NONE KNOWN].

12. Sealing, if requested. ☐ Applicant requests sealing under A.R.S. § 12-601(F) and states the qualifying protective-order, harassment-injunction, or stalking-victim basis: [DETAILS]. ☐ No sealing request is made.

Applicant requests that the Court enter a judgment changing Applicant's name from [CURRENT FULL LEGAL NAME] to [REQUESTED FULL LEGAL NAME], and grant any further relief allowed by law.

I declare under penalty of perjury that the foregoing is true and correct.

Applicant signature: __________________________

Printed name: [____________________________]

Date signed: [__/__/____]

Mailing address: [____________________________]

Telephone and email: [____________________________]