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Here is the text we could read:

ATTORNEY OR PARTY WITHOUT ATTORNEY

STATE BAR NUMBER:

FOR COURT USE ONLY

CONFIDENTIAL

NC-420

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:

DECLARATION IN SUPPORT OF APPLICATION TO FILE
DOCUMENTS UNDER SEAL IN NAME CHANGE PROCEEDING
UNDER ADDRESS CONFIDENTIALITY PROGRAM (SAFE AT HOME)

CASE NUMBER:

I have personal knowledge of the facts stated in this declaration and could and would testify competently to those facts.

I am a participant in the Secretary of State's confidential address program, Safe at Home.

I am seeking a name change (check all that apply):

declare as follows:

I (name):

a.
b.
c.

To avoid domestic violence.
To avoid stalking.
To avoid sexual assault.

To avoid human trafficking.

4. Facts showing that there is an overriding interest that overcomes the right of public access to the records in this name change

proceeding are (specify):

Continued on Attachment 4 (If you need more space, attach form MC-025.)

5. Facts showing that the overriding interest described in item 4 supports filing the documents in this name change proceeding under

seal are (specify):

Continued on Attachment 5. (If you need more space, attach form MC-025.)

Form Adopted for Mandatory Use
Judicial Council of California
NC-420 [Rev. January 1, 2019]

DECLARATION IN SUPPORT OF APPLICATION TO FILE
DOCUMENTS UNDER SEAL IN NAME CHANGE PROCEEDING UNDER
ADDRESS CONFIDENTIALITY PROGRAM (SAFE AT HOME)

Page 1 of 2

Code of Civil Procedure, § 1277;
California Rules of Court, rule 2.577
www.courts.ca.gov

PETITIONER:

CASE NUMBER:

NC-420

6. Facts showing that there is a substantial probability that the overriding interest described in item 4 will be prejudiced if the records

in this name change proceeding are not sealed are (specify):

Continued on Attachment 6. (If you need more space, attach form MC-025.)

7. Facts showing that an order sealing the records in this action is narrowly tailored to protect that overriding interest are (specify):

Continued on Attachment 7. (If you need more space, attach form MC-025.)

8. Facts showing that there is no less restrictive means to protect that overriding interest than filing the entire record under seal are
(specify, including facts that show why the law requiring the court to keep the current name and the proposed name confidential,
is not sufficient protection of that interest):

Continued on Attachment 8. (If you need more space, attach form MC-025.)

The number of pages attached is:

I declare under penalty of perjury under the laws of the State of California that the foregoing, including statements on all attachments,
is true and correct.

Date:

(TYPE OR PRINT NAME)

(SIGNATURE OF DECLARANT)

NC-420 [Rev. January 1, 2019]

Page 2 of 2

DECLARATION IN SUPPORT OF APPLICATION TO FILE DOCUMENTS
UNDER SEAL IN NAME CHANGE PROCEEDING UNDER ADDRESS
CONFIDENTIALITY PROGRAM (SAFE AT HOME)

Declaration in Support of Application to File Documents Under Seal in Name Change Proceeding Under Address Confidentiality Program (Safe at Home)

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): 39
Average fields per page: 19
Reading Level: Grade 7
LIST Grouping(s): Unknown

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_dom_viol was NC-420[0].Page1[0].DomViol[0] (0.52 conf)
n_c_page_stalking was NC-420[0].Page1[0].Stalking[0] (0.39 conf)
n_c_page_sex_assault was NC-420[0].Page1[0].SexAssault[0] (0.36 conf)
n_c_page_behalf was NC-420[0].Page1[0].OnBehalf[0] (0.34 conf)
n_c_page_petitioner_ft was NC-420[0].Page1[0].Petitioner_ft[0] (0.33 conf)
n_c_page_fill_text__1 was NC-420[0].Page1[0].FillText12[0] (0.39 conf)
n_c_page_fill_text__2 was NC-420[0].Page1[0].FillText11[0] (0.39 conf)
n_c_page_std_p_county was NC-420[0].Page1[0].StdP1Header_sf[0].CourtInfo[0].CrtCounty_ft[0] (0.40 conf)
n_c_page_std_p_info__1 was NC-420[0].Page1[0].StdP1Header_sf[0].CourtInfo[0].Branch_ft[0] (0.39 conf)
n_c_page_std_p_info_city was NC-420[0].Page1[0].StdP1Header_sf[0].CourtInfo[0].CityZip_ft[0] (0.40 conf)
n_c_page_std_p_street was NC-420[0].Page1[0].StdP1Header_sf[0].CourtInfo[0].Street_ft[0] (0.41 conf)
n_c_page_std_p_info__2 was NC-420[0].Page1[0].StdP1Header_sf[0].CourtInfo[0].MailingAdd_ft[0] (0.40 conf)
c_page_std_p_title_name was NC-420[0].Page1[0].StdP1Header_sf[0].TitlePartyName[0].Party1[0] (0.40 conf)
n_c_page_std_p_case_number was NC-420[0].Page1[0].StdP1Header_sf[0].CaseNumber[0].CaseNumber[0] (0.40 conf)
c_page_std_p_party_info__1 was NC-420[0].Page1[0].StdP1Header_sf[0].AttyPartyInfo[0].State[0] (0.43 conf)
n_c_page_std_p_header_info was NC-420[0].Page1[0].StdP1Header_sf[0].AttyPartyInfo[0].Zip[0] (0.43 conf)
c_page_std_p_party_city was NC-420[0].Page1[0].StdP1Header_sf[0].AttyPartyInfo[0].City[0] (0.43 conf)
n_c_page_std_p_party was NC-420[0].Page1[0].StdP1Header_sf[0].AttyPartyInfo[0].Street[0] (0.43 conf)
c_page_std_p_party_info__2 was NC-420[0].Page1[0].StdP1Header_sf[0].AttyPartyInfo[0].Firm[0] (0.43 conf)
c_page_std_p_info_name was NC-420[0].Page1[0].StdP1Header_sf[0].AttyPartyInfo[0].Name[0] (0.43 conf)
c_page_std_p_party_info__3 was NC-420[0].Page1[0].StdP1Header_sf[0].AttyPartyInfo[0].Phone[0] (0.43 conf)
c_page_std_p_header_party_info was NC-420[0].Page1[0].StdP1Header_sf[0].AttyPartyInfo[0].Fax[0] (0.43 conf)
c_page_std_p_info_email was NC-420[0].Page1[0].StdP1Header_sf[0].AttyPartyInfo[0].Email[0] (0.43 conf)
n_c_page_std_p_party_info__1 was NC-420[0].Page1[0].StdP1Header_sf[0].AttyPartyInfo[0].AttyFor[0] (0.41 conf)
n_c_page_std_p_party_info__2 was NC-420[0].Page1[0].StdP1Header_sf[0].AttyPartyInfo[0].BarNo[0] (0.43 conf)
n_c_page_attch__1 was NC-420[0].Page1[0].Attch4[0] (0.39 conf)
n_c_page_attch__2 was NC-420[0].Page1[0].Attch5[0] (0.39 conf)
n_c_page_fill_text__3 was NC-420[0].Page2[0].FillText56[0] (0.39 conf)
n_c_page_fill_text__4 was NC-420[0].Page2[0].FillText51[0] (0.39 conf)
n_c_page_fill_text__5 was NC-420[0].Page2[0].FillText52[0] (0.39 conf)
n_c_page_fill_text__6 was NC-420[0].Page2[0].FillText53[0] (0.39 conf)
n_c_page_fill_text__7 was NC-420[0].Page2[0].FillText47[0] (0.39 conf)
n_c_page_cb_choice__1 was NC-420[0].Page2[0].CBChoice1_cb[0] (0.39 conf)
n_c_page_case_number_ft was NC-420[0].Page2[0].#subform[0].CaseNumber_ft[0] (0.42 conf)
n_c_page_subform_petitioner_ft was NC-420[0].Page2[0].#subform[0].Petitioner_ft[0] (0.33 conf)
n_c_page_attch__3 was NC-420[0].Page2[0].Attch6[0] (0.39 conf)
n_c_page_attch__4 was NC-420[0].Page2[0].Attch7[0] (0.39 conf)
n_c_page_cb_choice__2 was NC-420[0].Page2[0].CBChoice1_cb[1] (0.39 conf)
n_c_page_date_field was NC-420[0].Page2[0].DateField1[0] (0.40 conf)

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

Declaration in Support of Application to File Documents Under Seal in Name Change Proceeding Under Address Confidentiality Program (Safe at Home)

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