CIVIL COVER SHEET. Washoe County, Nevada Case No. (Assigned by Clerk s Office) Civil Cases. Negligence Premises Liability -SF (Slip/Fall)

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1 I. Party Information CIVIL COVER SHEET Washoe County, Nevada Case No. (Assigned by Clerk s Office) Plaintiff(s)/Petitioner (name/address/phone): DOB: Attorney (name/address/phone): II. Nature of Controversy (Please check applicable bold category and applicable subcategory, if appropriate) Civil Cases Real Property Torts Negligence Landlord/Tenant - LT Negligence Auto - VP Unlawful Detainer - UD Negligence Medical/Dental - MD Title to Property Foreclosure - FC Negligence Premises Liability -SF (Slip/Fall) Liens - LE Negligence Other - NO Quiet Title - QT Specific Performance - SP Condemnation/Eminent Domain-CD Other Real Property - RO Partition - PT Planning/Zoning - PZ Probate Summary Administration - SU General Administration - FA Special Administration - SL Set Aside Estates - SE Trust/Conservatorships Individual Trustee - TR Corporate Trustee - TM Other Probate - OP Other Civil Filing Types Construction Defect - CF Chapter 0 General Breach of Contract Building & Construction - BC Insurance Carrier - BF Commercial Instrument - CI Other Contracts/Acct/Judg. - CO Collection of Actions - CT Employment Contract - EC Guarantee - GU Sale Contract - SC Uniform Commercial Code - UN Civil Petition for Judicial Review Foreclosure Mediation - FO Other Administrative Law - AO Department of Motor Vehicles-DM Worker s Compensation Appeal-SI Arbitration Requested Product Liability Product Liability/Motor Vehicle-VH Other Torts/Product Liability - PL Intentional Misconduct Torts/Defamation(Libel/Slander)-DF Interfere with Contract Rights - IR Employment Torts(Wrongful Term)-WT Other Torts - TO Anti-trust - AI Fraud/Misrepresentation - FM Insurance- IN Legal Tort- LG Unfair Competition - UC Appeal from Lower Court Transfer from Justice Court - TJ Justice Court Civil Appeal - CA Civil Writ Other Special Proceeding - SS Other Civil Filing Compromise of Minor s Claim - CM Conversion of Property - CN Damage to Property - DG Employment Security - ES Enforcement of Judgment - EJ Foreign Judgment Civil FJ Other Personal Property - PO. Recovery of Property - RE Stockholder Suit - ST Other Civil Matters GC Confession of Judgment - CJ Name Change Adult - NC Out of State Commission - OS Petition to Seal Criminal Records-PS III. Business Court Requested (If you check a box below, you must check an additional box above to determine case type.) NRS Chapters - Investments (NRS Art. ) Enhanced Case Mgmt/Business Commodities (NRS 0) Deceptive Trade Practices (NRS ) Other Business Court Matters Securities (NRS 0) Trademarks (NRS 00A) Date Signature of initiating party or representative Nevada AOC Planning and Analysis Division Form PA 01 JDC - Revised 0/1/0 Rev..E

2 Code $0 Name Address Telephone Number Acting In Proper Person IN THE SECOND JUDICIAL DISTRICT COURT OF THE STATE OF NEVADA IN AND FOR THE COUNTY OF WASHOE In the Matter of the Petition Of:, (Your present name) For a change of name. / Case No. Dept. No UPETITION FOR LEGAL CHANGE OF NAME, acting in proper person, (Your present name) petitions this Court as follows: I. Petitioner,, was born in, (Your present name) (City), on to (State) (Date of birth) (Father s name) and, who (Mother s name) (Were or were not) husband and wife. II. I wish to change my name from to because: REVISED /0 AA 1 N-1 PETITION

3 State reason for wanting name change III. I have been convicted of a felony. (Have or have not) If I have been convicted of a felony, each offense, the date of conviction, the County and State of conviction, and the final result are as follows: I am not seeking a name change for any illegal purpose. REVISED /0 AA N-1 PETITION

4 I currently reside at: IV. (Address) (Telephone number) and I have lived there since and have been a resident of Nevada (When you moved to present address) for. My previous address was: (Length of time you have lived in Nevada) (Your previous address), and I resided there for. (County, State, Zip Code) (How long you lived there) I am requesting that my name be legally changed to: V. (Clearly print your full new name as it will appear on all your legal documents) VI. 0BI (do or do not) wish to have a new birth certificate issued showing my new name as my original name. This document does not contain the Social Security number of any person. I declare, under penalty of perjury under the law of the State of Nevada, that the foregoing is true and correct. DATE: (Print name) (Signature) REVISED /0 AA N-1 PETITION

5 Code: Name: Address: Telephone Number: Appearing in Proper Person IN THE SECOND JUDICIAL DISTRICT COURT OF THE STATE OF NEVADA IN AND FOR THE COUNTY OF WASHOE 1 In the Matter of the Petition of, (Your Current Name) For a Change of Name. / Case No. Dept. No NOTICE On the day of, 0, a Petition was filed in the above-entitled Court by, requesting that the Court (Print your current name here.) legally change her/his present name of to (Print your current name here.). (Print your new name here.) Any opposition to this Petition should be filed with the above-entitled Court within ten () days of the final publication of this Notice. This document does not contain the Social Security number of any person. DATED this day of, 0. HOWARD W. CONYERS CLERK OF THE COURT By: Deputy Clerk REVISED /0 AA 1 N-1 NOTICE

6 Code: 1 Name Address Telephone No. Acting in Proper Person IN THE SECOND JUDICIAL DISTRICT COURT OF THE STATE OF NEVADA IN AND FOR THE COUNTY OF WASHOE 1 1 In The Matter of the Petition Of For change of Name. / Case No. Dept. No PROOF OF PUBLICATION Attached is the proof of publication of the Notice. This document does not contain the Social Security number of any person. I declare, under penalty of perjury under the law of the State of Nevada, that the foregoing is true and correct. DATED this day of,. (Signature) (Address) (Telephone number) 1

7 INDEX OF EXHIBITS Exhibit Number Number of Pages Exhibit Description Exhibit Number Number of Pages Exhibit Description Exhibit Number Number of Pages Exhibit Description

8 Exhibit

9 Code: 0 Name Address Telephone No. Acting in Proper Person IN THE SECOND JUDICIAL DISTRICT COURT OF THE STATE OF NEVADA In The Matterof the Petition of: IN AND FOR THE COUNTY OF WASHOE 1 (Your name) For Change of Name. / Case No. Dept. No REQUEST FOR SUBMISSION It is hereby requested that the Petition for Name Change and all other documents filed herein be submitted to the Court for decision. This document does not contain the Social Security number of any person. I declare, under penalty of perjury under the law of the State of Nevada, that the foregoing is true and correct. Date: (Print name) (Signature) (Address) (Telephone number) 1

10 Code: IN THE SECOND JUDICIAL DISTRICT COURT OF THE STATE OF NEVADA In the Matter of the Application of: (Your name) IN AND FOR THE COUNTY OF WASHOE For a change of Name. / ORDER CHANGING NAME Case No. Dept. No. This Court, having reviewed the Petition of (Your present name) to change name, proof of Publication having been filed and the statutory time (His or Her) to oppose having run and no opposition having been filed to the Petition, IT IS HEREBY ORDERED that the name of be and hereby is, legally changed from to. IT IS HEREBY FURTHER ORDERED that a new birth certificate issue (shall or shall not) indicating Petitioner s new name as Petitioner s original birth name. Dated: DISTRICT JUDGE 1