CIVIL CASE INFORMATION SHEET

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1 (e.g., John Smith v. All American Insurance Co; In re Mary Ann Jones; In the Matter of the Estate of George Jackson) A civil case information sheet must be completed and submitted when an original petition or application is filed to initiate a new civil, family law, probate, or mental health case or when a post-judgment motion for modification or enforcement is filed in a family law case. The information should be the best available at the time of filing. This sheet, approved by the Texas Judicial Council, is intended to collect information that will be used for statistical purposes only. It neither replaces nor supplements the filings or service of pleading or other documents as required by law or rule. The sheet does not constitute a discovery request, response, or supplementation, and it is not admissible at trial. 1. Contact information for person completing case information sheet: Names of parties in case: Person or entity completing sheet is: Attorney for Plaintiff/Petitioner Name: Plaintiff(s)/Petitioner(s): ì Pro Se Plaintiff/Petitioner Ö ²» Ó» ܱ» Title IV-D Agency Ö ²» Ó» ܱ» Other: Address: ïïï Ø Í»» City/State/Zip: Þ» ô Ì» ïîíìë Signature: Telephone: øëïî ìëìóïìëë Fax: State Bar No: Defendant(s)/Respondent(s): [Attach additional page as necessary to list all parties] Additional Parties in Child Support Case: Custodial Parent: Non-Custodial Parent: Presumed Father: 2. Indicate case type, or identify the most important issue in the case (select only 1): Civil Family Law Contract Injury or Damage Real Property Marriage Relationship Post-judgment Actions (non-title IV-D) Debt/Contract Assault/Battery Eminent Domain/ Annulment Enforcement Consumer/DTPA Construction Condemnation Declare Marriage Void Modification Custody Debt/Contract Defamation Partition Divorce Modification Other Fraud/Misrepresentation Other Debt/Contract: Malpractice Accounting Quiet Title Trespass to Try Title With Children No Children Title IV-D Enforcement/Modification Legal Other Property: Paternity Foreclosure Medical Reciprocals (UIFSA) Home Equity Expedited Other Professional Support Order Other Foreclosure Liability: Franchise Related to Criminal Insurance Motor Vehicle Accident Matters Other Family Law Parent-Child Relationship Landlord/Tenant Premises Expunction Enforce Foreign Adoption/Adoption with Non-Competition Product Liability Judgment Nisi Judgment Termination Partnership Asbestos/Silica Non-Disclosure Habeas Corpus Child Protection Other Contract: Other Product Liability Seizure/Forfeiture ì Name Change Child Support List Product: Writ of Habeas Corpus Protective Order Custody or Visitation Pre-indictment Removal of Disabilities Gestational Parenting Other Injury or Damage: Other: of Minority Grandparent Access Other: Parentage/Paternity Termination of Parental Employment Other Civil Rights Discrimination Retaliation Termination Workers Compensation Other Employment: Administrative Appeal Antitrust/Unfair Competition Code Violations Foreign Judgment Intellectual Property Lawyer Discipline Perpetuate Testimony Securities/Stock Tortious Interference Other: Other Parent-Child: Tax Tax Appraisal Tax Delinquency Other Tax Probate/Wills/Intestate Administration Dependent Administration Independent Administration Other Estate Proceedings 3. Indicate procedure or remedy, if applicable (may select more than 1): Appeal from Municipal or Justice Court Declaratory Judgment Arbitration-related Garnishment Attachment Interpleader Bill of Review License Certiorari Mandamus Class Action Post-judgment CIVIL CASE INFORMATION SHEET CAUSE NUMBER (FOR CLERK USE ONLY): COURT (FOR CLERK USE ONLY): STYLED In the Matter of the Change of Name of William Henry Doe Probate & Mental Health Guardianship Adult Guardianship Minor Mental Health Other: Prejudgment Remedy Protective Order Receiver Sequestration Temporary Restraining Order/Injunction Turnover

2 NOTICE: THIS DOCUMENT CONTAINS SENSITIVE DATA. IN THE MATTER OF THE The clerk fills out below. CHANGE OF NAME OF Case No: (Name of the child now) In the (check one): District County Justice Court of: William Henry Doe Travis County, Texas A CHILD Print your answers No discovery is intended in this case. I. PETITIONER Petition to Change the Name of a Child 1. My name is Ö ²» Marie Doe first middle last 2. My address is: 111 Hill Street, Bell, Texas II. III. ì Parent Managing Conservator Legal Guardian CHILD S LEGAL STATUS Check one. ì No court orders exist involving this child at this time. A court has made orders involving this child before, in the following case: Case number County & State Type of case (support, custody, adoption, etc.) CO-PETITIONER Check and complete either 1 or No other adult has a legal relationship with this child because: (check one): The other parent is dead. (Attach the death certificate.) Parental rights were terminated. (Attach the court order of Termination.) Petition to Change the Name of a Child February, 2014 Page 1 of 3

3 2. ì The following person has a legal relationship to this child. (That person must also sign this Petition in front of a notary to show s/he agrees with the name change.) IV. 1. Name: Relationship: ì Parent Managing Conservator Legal Guardian NAME CHANGE REQUEST 2. The reason I want to chan Son William Henry Doe has requested that his name be changed to Henry Peter Doe as a way to honor his grandfather. V. INFORMATION ABOUT THE CHILD 1. t name is: William Henry Doe 2. Home Address: 3. Social Security Number: 4. street address city state State that issued license 5. Date of birth and gender: May 1, 2002 ì Male Varón Female Mujer 6. Place of birth: month day year City County State Country 7. This child: is ì is not a registered sex offender. 8. John If the child is 10 or older, the child must fill out. If the child is a registered sex offender, you must fill out and submit a Sex Offender Update form to local law Petition and write Exhibit A at the top. James be entitled to. I swear under oath that the facts stated in this Petition are true and correct. Petition to Change the Name of a Child February, 2014 Page 2 of 3 Doe Henry Peter Doe 111 Hill Street, Bell Burke, Travis, Texas, United States of America Texas

4 Do not sign until you are in front of the notary! Petitioner signs in front of a notary Notary fills out below State of Texas, County of Date (Print the name of county where this affidavit is notarized.) Sworn to and subscribed before me, the undersigned authority, on this date: by. (Print the first and last names of the person who is signing this affidavit.) Do not sign until you are in front of the notary! Co-Petitioner signs in front of a notary Notary fills out below State of Texas, County of Date (Print the name of county where this affidavit is notarized.) Sworn to and subscribed before me, the undersigned authority, on this date: by. (Print the first and last names of the person who is signing this affidavit.) Petition to Change the Name of a Child February, 2014 Page 3 of 3

5 NOTICE: THIS DOCUMENT CONTAINS SENSITIVE DATA. Print court information exactly as it appears on your Petition IN THE MATTER OF THE CHANGE OF NAME OF (Name of the child now) A CHILD In the (check one): District County Justice Court of: Case No: William Henry Doe Travis Order to Change the Name of A Child A hearing took place today, and the following people were present. I. APPEARANCES 1. The Petitioner was present, without an attorney. ame: 2. Co- (the other parent): John James Doe 3. (check one): ì The Co-Petitioner was present and has signed below, agreeing to this Order. II. The Co-Petitioner was not present, but signed below, agreeing to this order. There is no Cobeen terminated by court order. County, Texas JURISDICTION The Court received evidence and finds that it has jurisdiction over this case and the parties, that the notice requirements have been met, and that the Petition meets all legal requirements. III. RECORD A Court Reporter (check one): did did not Ö ²» Marie Doe Order to Change the Name of a Child February 2014 Page 1 of 3

6 IV. FINDINGS llows: 1. : 2. Home Address: 3. Social Security Number: 4. street address city state State that issued license 5. Date of birth and gender: May 1, 2002 ì Male Varón Female Mujer 6. Place of birth: month day year City County State Country 7. The child (check one): ì is not a registered sex offender. is a registered sex offender, and the Petitioner notified local law enforcement of the request to change the 8. The request to change the name of this child is in the public interest, and is best for this child. V. ORDERS The Court orders the Current name: TO To this name: William Henry Doe 111 Hill Street, Bell Burke, Travis, Texas, United States of America (current name): William Henry Doe Henry Peter Doe Texas Order to Change the Name of a Child February 2014 Page 2 of 3

7 VI. Other Orders The court reserves the right to make further orders to clarify the above orders, if needed. Any orders requested that do not appear above are denied. Date of Judgment Mailing Address: Phone #: street address city state zip address: Fax # (if available): Co- Mailing Address: Phone #: 111 Hill Street, Bell, Texas øëïî ìëìóïìëë street address city state zip address: Fax # (if available): Order to Change the Name of a Child February 2014 Page 3 of 3

8 Print court information exactly as it appears on your Petition IN THE MATTER OF THE CHANGE OF NAME OF Case No: (Name of the child now) In the (check one): District County Justice Court of: William Henry Doe Travis County, Texas A CHILD Print your answers 1. My name is 2. My age is 3. The name change is for me. 4. I want my name changed to Child s Consent to Change Name first middle last Child prints his/her current name here: William Henry Doe Child signs here 12 William Henry Doe Henry Peter Doe Date the child signed Child s Consent to Name Change Jun Page 1 of 1

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