Presented by:

Petitioner

Street Address

City, State, Zip
King County District Court
State of Washington
_______________Division
		
		ORDER CHANGING NAME

In the matter of the Petition of			)
						)
__________________________________________	)	No. _______________________________________
						)

     The Petition of the above-named person for an order changing his/her present name, came regularly to be heard this date; the court having heard the evidence and it appearing to the satisfaction of the court that the allegations of the Petition for Change of Name are true; now therefore, it is hereby

     ORDERED, ADJUDGED AND DECREED that the name of ________________________________________

__________________________be changed to ______________________________________________________.

     DONE IN OPEN COURT this _______________________day of ___________________________. ______.

							__________________________________________
							           JUDGE/COURT COMMISSIONER
CERTIFICATION - State of Washington, County of King
The undersigned, duly authorized clerk of the King County District Court, Washington, hereby certifies that the document on which this stamp is imprinted is a true and correct copy of the original filed in the Court.  
Signed this ______ Day of ___________________, ______.
							
__________________________________________
			Court Clerk
(Order Changing Name)							                        KCDCF #64/98