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PETITION OF (Name of petitioner or petitioners):

NC-110

CASE NUMBER:

Petitioner GERALD DAVIDSON

FOR CHANGE OF NAME

NAME AND INFORMATION ABOUT THE PERSON
WHOSE NAME IS TO BE CHANGED

Attachment

of

Attachment to Petition (form NC-100 or form NC-200)
(You must use a separate attachment for each person whose name is to be changed. If petitioner is a guardian of a minor, a supplemental attachment, Declaration of Guardian (form NC-110G), must also be completed and attached for each minor whose name is to be changed.)
6. (Continued) Petitioner applies for a decree to change the name of the following person:
Self
Other
b.
(1) Present name (specify): GERALD DAVIDSON
(2) Proposed name (specify): GERALDINE DAVIDSON
(3) Born on (date of birth): July 28, 1980 over 18 years of age and presently under 18 years of age
New Mexico
(4) Born at (place of birth):
(5) Sex (as stated on original birth certificate):
Male
Female
(6) Current residence address (street, city, county, and zip code): 225 26th Street, Santa Monica, California 90401

Petitioner requests for a change of name because he is obtaining a sex reassignment surgery from being a male to a female.

c. Reason for name change (explain):

d. Relationship of the petitioner to the person whose name will be changed: near relative (indicate relationship):
(4)
(1) self parent
(5)
(2) other (specify): guardian (3)
e. If the person whose name will be changed is under 18 years of age, provide the names and addresses, if known, of the following persons: (address):
(1) Father (name):
(address):
(2) Mother (name):
(3) (Only if neither parent is living) Near relatives (names, relationships, and addresses):

f.

If the person whose name will be changed is 18 years of age or older, that person must sign the following declaration:

DECLARATION
I declare under penalty of perjury under the laws of the State of California that
I am not jurisdiction of the California Department of Corrections (in state prison or on parole) and required to register as a sex offender under Penal Code section 290.
Date: September 20, 2013

I am
I am