Type of Name Change

Who is the name change for?

Select an option Adult (self) Minor child

Reason for name change

Select an option Marriage Divorce Personal preference Gender Other

If other, please explain

Current Legal Name

Current First Name

Current Middle Name

Current Last Name

Proposed New Name

New First Name

New Middle Name

New Last Name

Personal Details

Date of Birth

Place of Birth

City, State, Country

State-Issued ID or Driver's License Number

Are you a U.S. Citizen?

Yes

No

Social Security Number (Full digits)

Criminal History

Have you ever been convicted of a felony?

Yes

No

Are you currently on probation or parole?

Yes

No

Are you a registered sex offender?

Yes

No

If yes to any above, please provide details

Minor Child Information (if applicable)

Child's Current Full Legal Name

Child's Proposed New Name

Child's Date of Birth

Your relationship to the child

Select an option Mother Father Legal Guardian

Other parent's full name

Other parent's address

Does the other parent consent to the name change?

Select an option Yes No

Are both parents deceased?

Yes

No

Court Filing Details

County where you reside

How long have you lived in this county

Have you previously filed a name change petition?

Yes

No

If yes, provide case number and county

Fee Waiver Eligibility

Do you want to request a fee waiver?

Yes

No

Are you currently receiving public benefits?

Yes

No

Which benefits?

Medi-CalFood Stamps/Calfresh/SNAPSSISSPIncome below poverty limit

Monthly household income (before taxes)

Number of people in household

Are you unable to pay for basic needs (food, shelter, clothing)?

Yes

No

Document Upload

Upload copy of current government-issued ID

Add attachment

Add attachment

Choose file

This file could not be attached because it exceeds the 50MB limit.

Please choose a file.

Cancel Upload

Upload any supporting documents (divorce decree, birth certificate, etc.)

Add attachment

Add attachment

Choose file

This file could not be attached because it exceeds the 50MB limit.

Please choose a file.

Cancel Upload

DISCLAIMER

Acknowledgment

I understand TruPoint LLC is a Nevada registered Document Preparation and does not provide legal advice or representation.

Yes

No

I certify that all information provided is true and correct.

Yes

No

NOTICE TO CONSUMER

As required by Nevada law. Please read each statement below and confirm you have read and understand it. If you have questions about any statement, contact our office before continuing.

I have read and understand that TruPoint LLC is not an attorney and cannot practice law.

Yes

No

I have read and understand that TruPoint LLC is not a law firm.

Yes

No

I have read and understand that TruPoint LLC cannot represent me in court

Yes

No

I have read and understand that TruPoint LLC cannot advise me about my legal rights or the law.

Yes

No

I have read and understand that TruPoint LLC cannot select legal forms for me.

Yes

No

FEES AND EXPENSES

I will provide you all the following services (list all services for which the client is being charged):

Standard Name Change $400 per petitionMinor Name Change $400 per petitionCourt fee will be calculate per JurdictionE-File $100Client will contact Journal for Publication

PAYMENT

ELECTRONIC SIGNATURE CONSENT

IMPORTANT- Please read carefully:

Your typed-name electronic signature applies ONLY to this questionnaire and the TruPoint service agreement. The actual deed and any documents that will be recorded with the County Recorder must be signed in handwritten ink and notarized in person.

CLIENT ELECTRONIC SIGNATURE

Type Your Full Legal Name

Date

Print Name:

Email Address (where signed copy will be sent)

Co-Client Electronic Signature (if applicable)

Type Your Full Legal Name

By typing my full legal name below, I confirm that I have read and understand each statement above, and that this notice was provided to me before I signed any documents. This typed name is my electronic signature.

Date

Print Name:

Email Address (where signed copy will be sent)