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Here is the text we could read:

ATTORNEY OR PARTY WITHOUT ATTORNEY

STATE BAR NUMBER:

NC-500

FOR COURT USE ONLY

NAME:

FIRM NAME:

STREET ADDRESS:

CITY:

TELEPHONE NO.:

E-MAIL ADDRESS:

ATTORNEY FOR (name):

MAILING ADDRESS:

CITY AND ZIP CODE:

BRANCH NAME:

SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS:

PETITION OF (name of each petitioner):

STATE:

FAX NO.:

ZIP CODE:

PETITION FOR RECOGNITION OF MINOR'S CHANGE OF GENDER AND
SEX IDENTIFIER AND FOR ISSUANCE OF NEW BIRTH CERTIFICATE

CASE NUMBER:

AND CHANGE OF NAME

Use this form only for a petition relating to a minor. (Petitioners 18 years or older must use form NC-300.) Before completing
this petition, read the Instructions for Filing Petition for Recognition of Minor's Change of Gender and Sex Identifier (form
NC-500-INFO).

• If you are seeking a name change in addition to recognition of gender change, complete items 8 or 9. If you are only
seeking recognition of gender change, skip these items.
• If the petition is being brought by a guardian, an attorney appointed as guardian ad litem for a dependent minor (Welf. &
Inst. Code, § 326.5), or an attorney for a minor under the jurisdiction of the juvenile court (Welf. & Inst. Code, § 601 or 602),
you must also complete Declaration of Guardian or Juvenile Attorney (form NC-510G).

INFORMATION ABOUT PETITIONER

1. This request is being made by (minor's present name):

and (check one of the following)

a.
b.
c.
d.

parent or parents (names):
guardian (name):
attorney for minor under jurisdiction of juvenile court (name):
near relative or friend (check only if all parents of minor are deceased and no guardian has been appointed)
Name and relationship to minor:

Petitioning minor either is a California resident or seeks a change to a California birth certificate.

3. Parents of minor (check one item below)
The minor has no living parent.
The minor has no living parent other than the parent or parents who have signed this petition.
Neither the minor nor the adult petitioner has any information about whether any non-signing parent is living.
The minor has one or more living parents who have not signed the petition (specify names and addresses):

a.
b.
c.
d.

Parent's Name:

Address:

Continued (Check this box if you need additional space. Attach a sheet of paper and write "Attachment 3d" for a title.)

(Check if petition is filed by a guardian or attorney appointed for minor under jurisdiction of juvenile court.)
This petition is supported by the information contained in attached Declaration of Guardian or Juvenile Attorney (form
NC-510G).

REQUEST FOR RECOGNITION OF CHANGE OF GENDER AND SEX IDENTIFIER
5. Petitioners request a decree recognizing that minor's gender and sex identifier is changed to:

female. b.

male.

nonbinary.

Form Adopted for Mandatory Use
Judicial Council of California
NC-500 [Rev. January 1, 2023]

PETITION FOR RECOGNITION OF MINOR'S CHANGE OF GENDER
AND SEX IDENTIFIER AND FOR ISSUANCE OF NEW BIRTH
CERTIFICATE AND CHANGE OF NAME

Page 1 of 2

Code of Civil Procedure, § 1277.5;
Health and Safety Code, §§ 103430, 103435

Date:

PETITION OF (name of each petitioner):

CASE NUMBER:

NC-500

(Check if petition does not include the signature of all living parents.) Petitioners request that the court issue an order on form
NC-520 directing any living parent who did not sign this petition to file written objections to show cause why this petition for
recognition of minor's change of gender and sex identifier should not be granted. (Form NC-520 is filed along with this
document.)

(Check if petition is filed by a guardian or guardian ad litem for minor, and all parents are deceased or cannot be located.)
Petitioners request that the court issue an order on form NC-520 directing that any living grandparent file written objections to
show cause why this petition for recognition of minor's change of gender and sex identifier should not be granted. (Form
NC-520 is filed along with this document.)

REQUEST FOR CHANGE OF NAME

A decree of change of name for the minor has already been obtained, and a certified copy of the decree is attached.

Petitioners request that the court decree that, to conform to minor's gender identity, the minor's name is changed to
(proposed name):

a. Petitioners provide the additional required information in support of this request for name change on the attached Name and

Information About the Person Whose Name Is to Be Changed (form NC-110).

This is the right court for the petition to change name because minor (check (1) or (2))

(1)
(2)

is a resident of this county.
does not reside in California and wants to change their birth certificate that was issued in this county.

Petitioners request that the court issue an order on form NC-520 directing all interested persons to file written objections to
show cause why the petition for change of name should not be granted. (Form NC-520 is filed along with this document.)

10.

Petitioners request the court to order that a new birth certificate be issued reflecting the recognition of gender change and any
name change sought by this petition.

11.

Number of pages attached (specify number):

DECLARATION

declare under penalty of perjury under the
I (minor's present name):
laws of the State of California that the request for a change in gender to (check one)
is to conform my legal gender to my gender identity and is not for any fraudulent purpose.

nonbinary

female

male

(TYPE OR PRINT NAME OF MINOR)

(SIGNATURE OF MINOR)

(TYPE OR PRINT NAME OF PETITIONING ADULT and RELATIONSHIP TO MINOR)

(SIGNATURE OF PETITIONING ADULT)

(TYPE OR PRINT NAME OF PETITIONING ADULT and RELATIONSHIP TO MINOR)

(SIGNATURE OF PETITIONING ADULT)

(TYPE OR PRINT NAME OF PETITIONING ADULT and RELATIONSHIP TO MINOR)

(SIGNATURE OF PETITIONING ADULT)

(TYPE OR PRINT NAME OF PETITIONER'S ATTORNEY)

(SIGNATURE OF PETITIONER'S ATTORNEY)

NC-500 [Rev. January 1, 2023]

Page 2 of 2

PETITION FOR RECOGNITION OF MINOR'S CHANGE OF GENDER AND
SEX IDENTIFIER AND FOR ISSUANCE OF NEW BIRTH CERTIFICATE
AND CHANGE OF NAME

Petition for Recognition of Minor's Change of Gender and Issuance of New Birth Certificate

This info page is part of the LIT Lab's Form Explorer project. It is not associated with the California state courts. To learn more about the project, check out our about page.

Downloads: You can download both the original form (last checked 2023-03) and the machine-processed form with normalized data fields.

About This Form:

Sourced from selfhelp.courts.ca.gov (2023-03)
Page(s): 2
Fields(s): 66
Average fields per page: 33
Reading Level: Grade 9
LIST Grouping(s): FA-00-00-00-00.

Use our Rate My PDF tool to learn more. Go beyond the above insights and learn more about this or any pdf form at RateMyPDF.com, includes: counts of difficult words used, passive voice decetion, and suggestions for how to make the form more usable.

Identified Data Fields:

We have done our best to automaticly identify and name form fields according to our naming conventions. When possible, we've used names tied to our question library. See e.g., user1_name. If we think we've found a match to a question in our library, it is highlighted in green. Novel names are auto generated. So, you will probably need to edit some of them if you're trying to stick to the convention.

Here are the fields we could identify.

n_c_page_p_title_name__1 was NC-500[0].Page1[0].P1Header[0].TitlePartyName[0].Party1_ft[0] (0.54 conf)
n_c_page_p_header_case_number was NC-500[0].Page1[0].P1Header[0].CaseNumber[0].CaseNumber_ft[0] (0.41 conf)
n_c_page_p_header_form_title_petitioner_cb was NC-500[0].Page1[0].P1Header[0].FormTitle[0].petitioner_cb[0] (0.35 conf)
n_c_page_p_info_county was NC-500[0].Page1[0].P1Header[0].CourtInfo[0].CrtCounty[0] (0.39 conf)
n_c_page_p_info_street was NC-500[0].Page1[0].P1Header[0].CourtInfo[0].CrtStreet[0] (0.39 conf)
n_c_page_p_header_info was NC-500[0].Page1[0].P1Header[0].CourtInfo[0].CrtMailingAdd[0] (0.41 conf)
c_page_p_header_info_city was NC-500[0].Page1[0].P1Header[0].CourtInfo[0].CrtCityZip[0] (0.37 conf)
n_c_page_p_info_branch was NC-500[0].Page1[0].P1Header[0].CourtInfo[0].CrtBranch[0] (0.39 conf)
n_c_page_p_party_info was NC-500[0].Page1[0].P1Header[0].AttyPartyInfo[0].AttyBarNo[0] (0.38 conf)
c_page_p_party_info_name was NC-500[0].Page1[0].P1Header[0].AttyPartyInfo[0].Name[0] (0.43 conf)
c_page_p_party_info_firm was NC-500[0].Page1[0].P1Header[0].AttyPartyInfo[0].AttyFirm[0] (0.43 conf)
c_page_p_party_info_street was NC-500[0].Page1[0].P1Header[0].AttyPartyInfo[0].Street[0] (0.43 conf)
c_page_p_party_info_city was NC-500[0].Page1[0].P1Header[0].AttyPartyInfo[0].City[0] (0.43 conf)
c_page_p_party_info_state was NC-500[0].Page1[0].P1Header[0].AttyPartyInfo[0].State[0] (0.43 conf)
c_page_p_header_party_info__1 was NC-500[0].Page1[0].P1Header[0].AttyPartyInfo[0].Zip[0] (0.43 conf)
c_page_p_party_info_phone was NC-500[0].Page1[0].P1Header[0].AttyPartyInfo[0].Phone[0] (0.43 conf)
c_page_p_header_party_info__2 was NC-500[0].Page1[0].P1Header[0].AttyPartyInfo[0].Fax[0] (0.43 conf)
c_page_p_party_info_email was NC-500[0].Page1[0].P1Header[0].AttyPartyInfo[0].Email[0] (0.43 conf)
c_page_p_header_party_info__3 was NC-500[0].Page1[0].P1Header[0].AttyPartyInfo[0].AttyFor[0] (0.43 conf)
n_c_page_list_fill_text was NC-500[0].Page1[0].List1[0].FillText16[0] (0.39 conf)
n_c_page_list_li_rb__1 was NC-500[0].Page1[0].List1[0].Li1A[0].Requester_rb[0] (0.40 conf)
n_c_page_list_li_fill_text__1 was NC-500[0].Page1[0].List1[0].Li1A[0].FillText16[0] (0.39 conf)
n_c_page_list_li_b_requester_rb was NC-500[0].Page1[0].List1[0].Li1B[0].Requester_rb[0] (0.40 conf)
n_c_page_list_li_b_text_field was NC-500[0].Page1[0].List1[0].Li1B[0].TextField6[0] (0.46 conf)
n_c_page_list_li_rb__2 was NC-500[0].Page1[0].List1[0].Li1C[0].Requester_rb[0] (0.40 conf)
n_c_page_list_li_text_field was NC-500[0].Page1[0].List1[0].Li1C[0].TextField[0] (0.46 conf)
n_c_page_list_li_rb__3 was NC-500[0].Page1[0].List1[0].Li1D[0].Requester_rb[0] (0.40 conf)
n_c_page_list_li_fill_text__2 was NC-500[0].Page1[0].List1[0].Li1D[0].FillText16[0] (0.39 conf)
n_c_page_list_li_parents__1 was NC-500[0].Page1[0].List3[0].Li3A[0].parents[0] (0.43 conf)
n_c_page_list_li_b_parents was NC-500[0].Page1[0].List3[0].Li3B[0].parents[0] (0.43 conf)
n_c_page_list_li_parents__2 was NC-500[0].Page1[0].List3[0].Li3C[0].parents[0] (0.43 conf)
n_c_page_list_li_parents__3 was NC-500[0].Page1[0].List3[0].Li3D[0].parents[0] (0.43 conf)
n_c_page_list_name__1 was NC-500[0].Page1[0].List3[0].Li3D[0].Sublist[0].Subli1[0].Grandfather1Name[0] (0.38 conf)
n_c_list_grandfather_add was NC-500[0].Page1[0].List3[0].Li3D[0].Sublist[0].Subli1[0].Grandfather1Add[0] (0.38 conf)
n_c_page_list_name__2 was NC-500[0].Page1[0].List3[0].Li3D[0].Sublist[0].Subli2[0].Grandmother1Name[0] (0.38 conf)
n_c_list_grandmother_add was NC-500[0].Page1[0].List3[0].Li3D[0].Sublist[0].Subli2[0].Grandmother1Add[0] (0.38 conf)
n_c_page_list_check_box__1 was NC-500[0].Page1[0].List3[0].CheckBox19[0] (0.41 conf)
n_c_page_list_parents_dead was NC-500[0].Page1[0].List4[0].ParentsDead_cb[0] (0.40 conf)
n_c_page_list_li_req_gender__1 was NC-500[0].Page1[0].List5[0].Li5A[0].ReqGender[0] (0.39 conf)
n_c_page_list_b_req_gender was NC-500[0].Page1[0].List5[0].Li5B[0].ReqGender[0] (0.39 conf)
n_c_page_list_li_req_gender__2 was NC-500[0].Page1[0].List5[0].Li5C[0].ReqGender[0] (0.39 conf)
n_c_page_p_title_name__2 was NC-500[0].Page2[0].P2Caption[0].TitlePartyName[0].Party1_ft[0] (0.39 conf)
n_c_page_p_case_number was NC-500[0].Page2[0].P2Caption[0].CaseNumber[0].CaseNumber_ft[0] (0.41 conf)
n_c_page_list_check_box__2 was NC-500[0].Page2[0].List6[0].CheckBox26[0] (0.41 conf)
n_c_page_list_check_box__3 was NC-500[0].Page2[0].List7[0].CheckBox21[0] (0.41 conf)
n_c_page_list_request__1 was NC-500[0].Page2[0].List8[0].request[0] (0.39 conf)
n_c_page_list_request__2 was NC-500[0].Page2[0].List9[0].request[0] (0.39 conf)
n_c_page_list_text_field was NC-500[0].Page2[0].List9[0].TextField[0] (0.42 conf)
n_c_page_list_b_location__1 was NC-500[0].Page2[0].List9[0].Li9B[0].Sublist9b[0].Li9B1[0].location[0] (0.36 conf)
n_c_page_list_b_location__2 was NC-500[0].Page2[0].List9[0].Li9B[0].Sublist9b[0].Li9B2[0].location[0] (0.36 conf)
n_c_page_list_check_box__4 was NC-500[0].Page2[0].List10[0].CheckBox10[0] (0.41 conf)
n_c_page_list_numeric_field was NC-500[0].Page2[0].List11[0].NumericField1[0] (0.42 conf)
n_c_page_declaration_fill_text was NC-500[0].Page2[0].Declaration[0].FillText44[0] (0.39 conf)
n_c_page_declaration_dgender__1 was NC-500[0].Page2[0].Declaration[0].dgender[0] (0.39 conf)
n_c_page_declaration_dgender__2 was NC-500[0].Page2[0].Declaration[0].dgender[1] (0.39 conf)
n_c_page_declaration_dgender__3 was NC-500[0].Page2[0].Declaration[0].dgender[2] (0.39 conf)
n_c_page_date_sig__1 was NC-500[0].Page2[0].Date[0].Date1[0].SigDate[0] (0.38 conf)
n_c_page_date__1 was NC-500[0].Page2[0].Date[0].Date1[0].T14[0] (0.36 conf)
n_c_page_date_sig__2 was NC-500[0].Page2[0].Date[0].Date2[0].SigDate[0] (0.38 conf)
n_c_page_date__2 was NC-500[0].Page2[0].Date[0].Date2[0].T14[0] (0.36 conf)
n_c_page_date_sig__3 was NC-500[0].Page2[0].Date[0].Date3[0].SigDate[0] (0.38 conf)
n_c_page_date__3 was NC-500[0].Page2[0].Date[0].Date3[0].T14[0] (0.36 conf)
n_c_page_date_sig__4 was NC-500[0].Page2[0].Date[0].Date4[0].SigDate[0] (0.38 conf)
n_c_page_date__4 was NC-500[0].Page2[0].Date[0].Date4[0].T14[0] (0.36 conf)
n_c_page_date__5 was NC-500[0].Page2[0].Date[0].Date5[0].Date[0] (0.36 conf)
n_c_page_date_print_name was NC-500[0].Page2[0].Date[0].Date5[0].PrintName[0] (0.38 conf)

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The Legal Innovation & Technology Lab's Form Explorer Beta @ Suffolk Law School Last updated 2023-04-02

Petition for Recognition of Minor's Change of Gender and Issuance of New Birth Certificate

About This Form:

Identified Data Fields:

Create an Interactive Version of this Form:

The Legal Innovation & Technology Lab's Form Explorer ^Beta @ Suffolk Law School Last updated 2023-04-02