In the  District Court of Utah 

__________ Judicial District ________________ County 

Court Address ______________________________________________________ 

In the matter of the name change of 

Order Changing Minor's Name 

_____________________________________ 
(Minor's name) 

_______________________________ 
Case Number 

_______________________________ 
Judge 

Petitioner and the minor appeared in Court on: ______________________ (date). 

The minor was born on: ______________________ (date). 

A minor. 

1. 

2. 

3. 

The minor’s birth name was: 

First name 

Middle name (if any) 

Surname 

 

 

 

The court finds: 

4. 

(a)  All notices required by law have been given. 

(b) 

[  ]  No objections to the proposed name change were made. 

(c) 

[  ] Objections to the proposed name change were made by: 

 

 

_________________________________________________________ 

(d)   [  ]  Written consent to the proposed name change has been filed by:  

[  ]  ________________________________________________ (name), 

[  ]  ________________________________________________ (name), 

the minor's parent 

the minor's parent 

Approved April 13, 208 / Revision approved by 
Forms Committee October 18, 2021 
 

Order Changing Minor’s Name 

Page 1 of 4 

[  ]  ________________________________________________ (name), 

[  ]  ________________________________________________ (name), 

[  ]  ________________________________________________ (name), 

the minor's custodian 

the minor's guardian 

other, who is minor’s  

 _______________________________________ (specify relationship) 

(e)   [  ]  The allegations in the petition are true. 

(f) 

[  ]  The requests in the petition are not for a wrongful or fraudulent purpose. 

5. 

(a)  The requirements of Utah Code Section 42-1-1 through 42-1-3 have been 

(b)  The minor is not on the Child Abuse Offender Registry and is not barred 

from changing their name. (Utah Code 77-43-105(7)). 

(c)  The minor: 

 

[  ] 

is not on the Sex and Kidnap Offender Registry. 

[  ] 

is on the Sex and Kidnap Offender Registry, but granting the petition is 
not against the public interest (Utah Code 77-41-105(8)(a)). 

6.  

[  ]  The allegations in the petition are sufficient and the petition should be 

granted. 

7. 

The name change  [  ] is    [  ]  is not     in the best interest of the minor. 

(g) 

[  ] Other findings (if any):   

   

met. 

The court concludes: 

The court orders: 

8. 

The Petition is   

[  ]  granted    [  ]  denied 

9. 

[  ]  The minor’s current legal name of 

Approved April 13, 208 / Revision approved by 
Forms Committee October 18, 2021 
 

Order Changing Minor’s Name 

Page 2 of 4 

This new name may be entered on birth certificate and used as the minor’s legal 
name from this date forward. 

udge’s signature may instead appear at the top of the first page of this document. 

Signature ► 

Judge 

 

 

  J

 
Date 

First name 

Middle name (if any) 

Surname 

is changed to 

First name 

Middle name (if any) 

Surname 

 

 

 

 

 

 

Approved April 13, 208 / Revision approved by 
Forms Committee October 18, 2021 
 

Order Changing Minor’s Name 

Page 3 of 4 

 

 

 

 
Date 

 

I certify that I filed with the court and am serving a copy of this Order Changing Minor's on the following 
people.  

Certificate of Service 

Person’s Name 

Service Method 

Service Address 

Service 
Date 

 

 

 

 

[  ]  Mail 
[  ]  Hand Delivery 
[  ]  E-filed 
[  ]  Email  
[  ]  Left at business (With person in charge 

or in receptacle for deliveries.) 

[  ]  Left at home (With person of suitable 

age and discretion residing there.) 

[  ]  Mail 
[  ]  Hand Delivery 
[  ]  E-filed 
[  ]  Email  
[  ]  Left at business (With person in charge 

or in receptacle for deliveries.) 

[  ]  Left at home (With person of suitable 

age and discretion residing there.) 

Signature ► 

Printed Name 

 

 

Approved April 13, 208 / Revision approved by 
Forms Committee October 18, 2021 
 

Order Changing Minor’s Name 

Page 4 of 4