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____________ DISTRICT COURT, ______________________ COUNTY, UTAH 

OURT’S ADDRESS:  _____________________________________________________ 

 

N THE MATTER OF THE   
NAME CHANGE OF: 

_____________________________,. 
(minor’s name) 

         A minor. 

PPLICATION FOR APPOINTMENT  

OF A GUARDIAN AD LITEM     
      

Case No. ____________________ 

udge  _______________________ 

y name is __________________________________________, and I am the Applicant. 

                   (name of person asking for appointment of guardian ad litem) 

I ask this court to appoint a guardian ad litem to represent the minor in this name change action.  

Without a guardian ad litem, the minor’s interests will not be properly represented.   

I ask that _______________________________________________ be appointed as  
 

    (name or names of proposed guardian(s) ad litem) 

guardian ad litem(s) for _______________________________________________________.  
 

(name of minor) 

 

 

 

Minor’s Name Change:  Application for Appointment of G.A.L., p. 1                   Approved:  November 19, 2004 

 

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

 

   

 

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  _

     

   

 

If a guardian ad litem is appointed:  

[ ] no costs are anticipated for this guardian ad litem. 

[ ] I will pay all costs for the guardian ad litem.  

[ ] the court should justly and equitably apportion costs for the guardian ad litem between 
the litigants 

 

     

Minor’s Name Change:  Application for Appointment of G.A.L., p. 2                   Approved:  November 19, 2004 

DATED:  _________________________ 

__________________________________________ 
Applicant’s signature 

 

NOTARY CLAUSE 

__________________________, Affiant, is personally known to me or presented 
 
satisfactory proof of identity.  After being sworn and while under oath, Affiant stated that he or 
she was acting voluntarily, had read and understood the preceding document, and that the 
contents were true. Affiant then signed the document in my presence. 

igned on _________________, 20____.    X_________________________________________ 

     Notary Public/Court clerk 

Notary Seal) 

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CERTIFICATE OF DELIVERY 
 

On  _________________________ (date),  I [ ] hand-delivered, [ ] mailed by first class 

mail, postage prepaid, a copy of the foregoing APPLICATION FOR APPOINTMENT OF 
GUARDIAN AD LITEM to: 
 

ame: 
Address: 

  N

 

Minor’s Name Change:  Application for Appointment of G.A.L., p. 3                   Approved:  November 19, 2004 

 

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___________________________________ 
Applicant 

    _

 

 

 

Name: 
Address: 

Name: 
Address: 

Minor’s Name Change:  Application for Appointment of G.A.L., p. 4                   Approved:  November 19, 2004