In the District Court of Utah 

__________ Judicial District ________________ County 

Court Address ______________________________________________________ 

In the Matter of the Name Change of: 

Order on Petition for Name Change 

_____________________________________ 
Petitioner 

_______________________________ 
Case Number 

_______________________________ 
Judge 

Petitioner appeared in court on _______________________ (date). 

Petitioner was born on: _______________________ (date). 

The name on petitioner’s birth certificate is: 

 

First name 

Middle name(s) (if any) 

Last name 

 

 

The court finds: 

[  ]  All the notices required by law have been given. 

Objections (Choose one.): 

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

1702FAJ Approved March 11, 2022 

Order on Petition for Name Change 

Page 1 of 4 

ity, State, Zip 

 
Name 

ddress 

hone 

mail 

  A

  C

  P

  E

1. 

2. 

3. 

4. 

5. 

 

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

______________________________________________________________ 

6. 

[  ]  The statements in the petition are accepted as true. 

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

[  ]  is not on the Child Abuse Offender Registry  

[  ]  is on the Child Abuse Offender Registry. 

11.  Petitioner (Choose one.):  

[  ]  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)). 

12.   The statements in the petition (Choose one.):  

[  ]  are sufficient and the petition should be granted. 

[  ]  are not sufficient and the petition should not be granted. 

Having considered the documents filed with the court, the evidence and the arguments, 
and now being fully informed, 

9. 

The requirements of Utah Code 42-1-1 through 42-1-3 (Choose one.): 

   

[  ]  Other findings (if any): 

8. 

 

 

The court concludes: 

[  ]  have been met. 

[  ]  have not been met. 

10.  Petitioner (Choose one.):  

The court orders: 

13. 

The Petition is   

[  ]  granted    [  ]  denied 

1702FAJ Approved March 11, 2022 

Order on Petition for Name Change 

Page 2 of 4 

 

14. 

[  ]  Petitioner’s legal name is changed to: 

First name 

Middle name(s) (if any) 

Last name 

 

 

 

Petitioner may use this new legal name from this date forward. 

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

 

 
Date 

Signature ► 

Judge 

 

 

1702FAJ Approved March 11, 2022 

Order on Petition for Name Change 

Page 3 of 4 

 

Certificate of Service 

I certify that I filed with the court and am serving a copy of this Order on Petition for Name Change on the 
following people.  

(Only required if there were other interested parties in this case). 

Person’s Name 

Service Method 

Service Address 

 

 

[  ]  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 

 

 

(Interested party or 
attorney) 

(Interested party or 
attorney) 

 
Date 

Service 
Date 

 

 

1702FAJ Approved March 11, 2022 

Order on Petition for Name Change 

Page 4 of 4