City, State, Zip 

 
Name 

 
Address 

 
Phone 

 
Email  

 

If you do not respond to this 
document within applicable time 
limits, judgment could be entered 
against you as requested. 

 
 
 
 
 
 
 
Check your email. You will receive information and 
documents at this email address.  
 

I am   [  ]  Petitioner 

[  ]  Petitioner’s Attorney 

 

In the  District Court of Utah 

__________ Judicial District ________________ County 

Court Address ______________________________________________________ 

In the matter of the name change of 

Petition for Minor's Name Change 
(Utah Code 42-1-1) 

_____________________________________ 
(Minor's name) 

_______________________________ 
Case Number 

A minor. 

_______________________________ 
Judge 

1. 

I am asking this Court to change the name of a minor.  (A minor is a person who 
is less than 18 years old.) 

2. 

I ask the Court to change the minor’s name to:  

 

First name 

Middle name (if any) 

Surname 

 

 

3. 

My relationship to the minor is: 

[  ]  parent  

[  ]  other (such as custodian or guardian; court order must be attached):   

_____________________________________________________________ 

Approved November 19, 2004 / Revision 
approved by Forms Committee October 18, 2021 
 

Petition for Minor’s Name Change 

Page 1 of 4 

* Minor must live in county where petition is filed 
** Minor must live in this county for at least one year before the petition is filed. 

5.   

If I am not the minor’s legal guardian or custodian, I have attached a copy of the 
court orders appointing the guardian or custodian. Here is what I know about 
those orders: 

Date signed by judge 

Case number 

Court name 

 

 

 

 

 

 

6. 

[  ]  The following people may be entitled to notice: 

Copy 
attached? 

 

 

[  ]  _______________________________________________ (parent's name) 

[  ]  has agreed to the proposed name change.  
 

Their original signed consent is attached, or it will be filed before the 
hearing on this petition.   

[  ]  has not agreed to the proposed name change.  
 

They will be served a copy of this petition, along with a summons 
requesting a written response within 21 days if served in Utah (or 
within 30 days if served outside of Utah). 

 

Approved November 19, 2004 / Revision 
approved by Forms Committee October 18, 2021 
 

Petition for Minor’s Name Change 

Page 2 of 4 

4. 

The following information describes the minor: 

 

 

 

 

 

 

   

     

Name on birth certificate: 

Date of birth: 

Place of birth: 

Minor’s current address:  * 

Date when minor began living in county 
where petition is filed:  **  

Name of adult who lives with minor, has 
physical custody, and provides care 

Parents’ names: 

Parents’ current addresses: 
(list both addresses if  
they aren’t the same) 
 

[  ]  ___________________________________________ (other parent's name) 

[  ]  has agreed to the proposed name change.  
 

Their original signed consent is attached, or it will be filed before the 
hearing on this petition.   

[  ]  has not agreed to the proposed name change.  
 

They will be served a copy of this petition, along with a summons 
requesting a written response within 21 days if served in Utah (or 
within 30 days if served outside of Utah). 

[  ]  _______________________________________________ (guardian, 

conservator, Guardian ad Litem) 

[  ]  has agreed to the proposed name change.  
 

Their original signed consent is attached, or it will be filed before the 
hearing on this petition.   

[  ]  has not agreed to the proposed name change.  
 

They will be served a copy of this petition, along with a summons 
requesting a written response within 21 days if served in Utah (or 
within 30 days if served outside of Utah). 

7. 

The new name will benefit the minor. Here are the reasons why: 

(In the lines below, describe any of the following facts that apply, or others: 

(a)  how a name change will develop and preserve the minor’s relationship with each parent; 
(b)  how long the minor has used the present name or proposed name; 
(c)  difficulties embarrassment, or harassment caused by the present name; and 
(d) whether the present name causes insecurity and lack of identity.) 

 

_____________________________________________________________________________ 

_____________________________________________________________________________ 

_____________________________________________________________________________ 

[Check a box below for the correct paragraph 8. Cross out the incorrect paragraph 8, to show it does not 
apply.] 

8. 

[  ]  The minor is old enough to make intelligent and decisive choices, and wants 

to make this name change because: 

 ________________________________________________________________________ 

________________________________________________________________________ 

[  ]  The minor is not old enough to make an intelligent and decisive choice 

about this name change. 

9.   

It is in the minor’s best interest to change to the proposed new name. 

Approved November 19, 2004 / Revision 
approved by Forms Committee October 18, 2021 
 

Petition for Minor’s Name Change 

Page 3 of 4 

10. 

There is no reason why the minor’s name should not be changed. 

11.  Except for this petition, the minor is not presently involved in any legal 

proceeding.  

12. 

The minor is not on probation or parole.    

13.    The minor is not on the Child Abuse Offender Registry. (Utah Code 77-43-105(7))  

14. 

The minor is  (Choose one.):  

[  ]  not on the Sex and Kidnap Offender Registry. 

[  ] 

is on the Sex and Kidnap Offender Registry. Changing their name is not 
against the public interest because (Explain.): 

15. 

I am filing a Certification Regarding Offender Registry completed by the Utah 
Department of Corrections. 

16.   

I am not changing the minor’s name to avoid creditors or anyone else with a 
claim against the minor, or for any other wrongful purpose. 

17.   This name change will not affect any right, title, or interest of anyone else, except 

for the parent, custodian, or guardian named above. Any parent, custodian, or 
guardian who has not provided a written consent to this name change will be 
served with this petition pursuant to Rule 4 of the Utah Rules of Civil Procedure, 
and have an opportunity to participate in these name change proceedings.  

18. 

If it is not possible to serve the other parent, then I will prepare and file the 
pleadings necessary to ask the Court to waive service    

[Note to petitioner:  Those pleadings are described in the instructions, and are called (1) Motion to 
Waive Service (2) Petitioner’s Affidavit in Support of Motion to Waive Service, and (3) Order to 
Waiver Service.] 

I declare under criminal penalty under the law of Utah that everything stated in this document is true. 

Signed at ______________________________________________________ (city, and state or country). 

 
Date 

 

Signature ► 

Printed Name 

 

 

Approved November 19, 2004 / Revision 
approved by Forms Committee October 18, 2021 
 

Petition for Minor’s Name Change 

Page 4 of 4