Name change 110 form Essay

Submitted By tahmidaalam
Words: 521
Pages: 3

To keep other people from seeing what you entered on your form, please press the Clear This Form button at the end of the form when finished.
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