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?*

YesNo
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.
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?*

YesNo
Nevada county where you will file the petition*
SECTION C — Reason for Name Change
What is your reason for requesting a name change?*

Conform to my gender identityOther (please explain)
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?*

YesNo
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.*

I affirm this statement.
SECTION F — Birth Certificate Preference
Do you want the name on your birth certificate changed?*

YesNo
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.

I affirm this statement.
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.

I understand that Deborah Barnhart, dba DPS of Northern Nevada, is not an attorney and is acting solely as a legal document preparer.
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