Adult Name Change

Adult Name Change

Please complete this questionnaire to provide the information needed to prepare your Petition for Name Change (Adult).
NRS240A DISCLAIMER - Read Carefully.

I, DEBORAH BARNHART, DOING BUSINESS AS DPS OF NORTHERN NEVADA, AM NOT AN ATTORNEY IN THE STATE OF NEVADA. I AM NOT AUTHORIZED TO GIVE LEGAL ADVICE OR LEGAL REPRESENTATION. I MAY NOT ACCEPT FEES FOR GIVING LEGAL ADVICE OR LEGAL REPRESENTATION.
SECTION A — Petitioner Info
Current legal name

First NameMiddle NameLast NameSuffix
New name requested

First NameMiddle NameLast NameSuffix
Date of birth

MonthDayYear
Date
Age
Place of birth (City, State)
Mailing address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Is your physical address different from your mailing address?
Physical address (if different)

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Email address
example@example.com
Phone number
Please enter a valid phone number.Format: (000) 000-0000.
SECTION B — Residency
Nevada county of residence
Date you began residing in this Nevada county

MonthDayYear
Date
Do you intend to live in Nevada indefinitely?
Nevada county where you will file the petition
SECTION C — Reason for Name Change
What is your reason for requesting a name change?
If you selected 'Other,' please explain why you want to change your name.
SECTION D — Criminal History
Have you ever been convicted of a felony?
If yes, list ALL felony convictions (offense, date of conviction, county/state)
SECTION E — Fraud Declaration
I am not requesting this name change to defraud creditors or for any other fraudulent purpose.
SECTION F — Birth Certificate Preference
Do you want the name on your birth certificate changed?
If you answered 'No' above, please check below: I am requesting the court order to grant the name change going forward only (that from here on out I am known as the new name), not to amend the birth certificate.
SECTION G — NRS 240A DISCLOSURE

Please review and confirm the information below.
I, DEBORAH BARNHART, DOING BUSINESS AS DPS OF NORTHERNNEVADA, AM NOT AN ATTORNEY IN THE STATEOF NEVADA. I AM NOT AUTHORIZED TO GIVE LEGAL ADVICE OR LEGAL REPRESENTATION. I MAY NOT ACCEPT FEES FORGIVING LEGAL ADVICE OR LEGAL REPRESENTATION.
Electronic signature (type your full name)
Date

MonthDayYear
Date
This intake is for information-gathering only to prepare a Petition for Adult Name Change and related filings.
Should be Empty:

Adult Name Change

NRS240A DISCLAIMER - Read Carefully.

SECTION A — Petitioner Info

SECTION B — Residency

SECTION C — Reason for Name Change

SECTION D — Criminal History

SECTION E — Fraud Declaration

SECTION F — Birth Certificate Preference

SECTION G — NRS 240A DISCLOSURE