O

 

 

       

 

____________ DISTRICT COURT, ______________________ COUNTY, UTAH 

OURT’S ADDRESS:  _____________________________________________________ 

 

N THE MATTER OF THE   
NAME CHANGE OF: 

_____________________________,. 
(minor’s name) 

         A minor. 

RDER APPOINTING 
GUARDIAN AD LITEM     
      

Case No. ____________________ 

Judge  _______________________ 

here is good cause to support the application of ______________________________ 
 

(name of applicant) 

 

 

 

 

 

for the appointment of a guardian ad litem to represent the minor in this name change action.   

t is ordered that ______________________________________________be appointed  

 

     (name of guardian(s) ad litem 

as guardian ad litem for  _____________________________________________________ in  
 

        (name of minor) 

 

 

this name change action. 
 

Minor’s Name Change:  Order Appointing G.A.L.., p. 1                                      Approved:  November 19, 2004 

_____________________________ 
(Applicant’s Name) 
_____________________________  
(Address) 
_____________________________  
(City) 
_____________________________  
(Telephone) 

 

   

 

  C

 

   I

  _

   

   

 

 

  T

 

  I

 

 

The costs of the guardian ad litem are apportioned as follows: 

[ ] No costs are anticipated. 

[ ] Costs for the guardian ad litem will be paid for by 

________________________________ (name and percentage of costs to be paid). 

________________________________ (name and percentage of costs to be paid). 

________________________________ (name and percentage of costs to be paid). 

________________________________ (name and percentage of costs to be paid). 

Minor’s Name Change:  Order Appointing G.A.L.., p. 2                                      Approved:  November 19, 2004 

ATED: ___________________ 

 

 

 

 

______________________________________ 
District Court Judge 

 

CERTIFICATE OF DELIVERY 

On  __________________________ (date),  I [ ] hand-delivered, [ ] mailed by first class 
mail, postage prepaid, a copy of the foregoing ORDER FOR APPOINTMENT OF GUARDIAN 
AD LITEM to: 
 

____________________________________ 
Applicant=s Signature 

  D

 

Name: 
Address: 

Name: 
Address: 

Name: 
Address: 

 

 

 

 

 

 

 

 

Minor’s Name Change:  Order Appointing G.A.L.., p. 3                                      Approved:  November 19, 2004