Name (currently used) 

 
Address 

 
City, State, Zip 

 
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   (Utah Bar #:__________)  

          [  ] Petitioner’s Licensed Paralegal Practitioner (Utah Bar #:__________) 

In the District Court of Utah 

__________ Judicial District ________________ County 

Court Address ______________________________________________________ 

In the Matter of the Name Change of: 

Petition for Name Change 
(Utah Code 42-1-1) 

_____________________________________ 
Petitioner (current legal name) 
 

_______________________________ 
Case Number 

_______________________________ 
Judge 

1. 

I live in ____________________________ County, Utah and have lived here  

since _______________________ (date), which is at least one year. 

I was born on: _______________________ (date). 

The name on my birth certificate is:  

 

First name 

Last Name 

Middle name(s) (if any) 

 

 

2. 

3. 

 

1700FAJ Approved March 11, 2022 
 

Petition for Name Change 

Page 1 of 3 

 

I ask the court to order that my legal name be (proposed new name): 

 

Middle name(s) (if any) 

First name 

Last Name 

 

 

I want to change my name because: 

I do not know any reason why I should not be allowed to change my name. 

Except for this petition, I am not involved in any court actions or proceedings. 

I am not on probation or parole. 

I am not on the Child Abuse Offender Registry. (Utah Code 77-43-105(7))  

10. 

I am (Choose one.): 

[  ]  not on the Sex and Kidnap Offender Registry. 

[  ]  on the Sex and Kidnap Offender Registry. Changing my name is not against 

the public interest because (Explain.): 

 

11. 

12. 

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

I am not changing my name to avoid creditors or anyone else with a claim 
against me, or for any other wrongful purpose. 

13.  My name change will not affect any right, title, or interest of anyone else, and I do 

not know of anyone else who should be notified of this petition. 

14. 

I request a hearing. 

1700FAJ Approved March 11, 2022 
 

Petition for Name Change 

Page 2 of 3 

   

. 

  4

5. 
 

6. 

7. 

8. 

9. 

 

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

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

Signature ► 

Printed Name 

 

 

  I

 

 
Date 

1700FAJ Approved March 11, 2022 
 

Petition for Name Change 

Page 3 of 3