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NC-200
ATTORNEY OR PARTY WITHOUT ATTORNEY STATE BAR NUMBER;
NAME: DQKMQ, DOJMU Alk$+
FIRM NAME:
Bat“ A09 LIV“ AIM rb$
‘9?
STREET ADDRESS: I E
CC¢ 59m
CITY: LA
STATE: ZIPCODE:q ‘3)? lo -
TELEPHONENo.:
S {q § us (4?? fl FAxNo.:
E-MAIL ADDRESS:
MQX‘KQ‘“
‘1‘ . m¢§\@gflfi\\ aLON
‘
H L E
ATTORNEY FOR
(name):
Ii
“ Bro m(
SUPERIOR COURT 0F c'eLIEORNIA, COUNTY 0F
F re, 5 (\0 JUL 1 1 2022
STREET ADDRESS:H30 ions re Q&-
MAILING ADDRESS:
[l30 O $¥F€€¥ SUPERIOR COURT OF CALIFORNIA
COUNTY OF FRESNO
CITYAND CODE;
ZIP
F r Ls“ o I PX (‘3? }\ BY
BRANCH NAME:
R v; ' S; $\l (b\k (\\ mo‘ks Q
DEPUTY
PETITION 0F (name): i“ rQIZ— fngqun mm QA 9053‘
PETITION FOR CHANGE 0F NAME, RECOGNITION OF CHANGE OF
GENDER, AND ISSUANCE OF NEW BIRTH CERTIFICATE
CASE ”UM
T2 ‘
u cc 0 2 0 5 9
Befor_e you comglete this petition, ou should read thg Instquctions for Filing on the ne_)gt pa_ge. You mujst answer all
questions and c eck all boxes tha appjy to you on thls petgtlon. You must fl e thls petltlon m the superior court of the
county where the person whose name Is to be changed resndes.
1. name):
Petitioner (present DUAL“) *0. (Do. (\i QA Dubs 5r is 18 years old or older
and a resident of this county.
2. decree that
Petitioner requests that the court name
petitioner's ischanged, inorder to conform to petitioner's gender identity. to
g
’
(proposed name): M \’\
IQ, (k \Mo» “§(‘mx gw53<
3. a decree recognizing that the
Petitioner requests gender
petitioner's ischanged to:
a. female.
b.
c.
E
E
male.
nonbinary.
4. new
Petitioner requests that the court order that a be issued reflecting the gender and name changes sought by
birth certificate
this petition.
5. an order directing any interested persons to file written objections to show cause why
Petitioner requests that the court issue
name
the petition for change of should not be granted.
6. insupport of this
Petitioner provides the following information petition:
a. The declaration below.
b—f. The information contained inthe attachment (attach a completedcopy of the attachment Name and Information About the
Person Whose Name ls toBe Changed (form NC-110)).
I(present name):
t
ngqflrmmmu
request for a change in
I
wm
gender to (check one)
5‘, DECLARATION
female E male E
declare under penalty of perjury under the laws of the state of California that the
nonbinary istoconform my legalgender tomy
gender and
identity isnot for any fraudulent purpose.
Date: ?'I “I }O%g\ ‘
DMAOW (TYPEOR
(\BM‘xek Qws*
PRINT NAME OF PETITIONER)
} (MLW/EM‘Q/VM (SIGNATURE 0F PETITIONER)
on next page)
(Instructions Page1of 2
Form AdoptedforMandamn/Use PETITION
Judicial Council of California
FOR CHANGE OF‘NAME, RECOGNITION 0F CHANGE Codevfcw" Procedurefiwfietsew:
Health and Safety Code. §§ 103430, 103435
Nc-2oo[Rev.5eptember1,2o1a] OF GENDER, AND ISSUANCE OF NEW BIRTH CERTIFICATE www.courts-cagov
NC-200
INSTRUCTIONS FOR FILING A PETITION FOR CHANGE 0F NAME AND GENDER
1. Where to File
The change
petition for ofname and gender must be filed'In the superior court'1n the county
where the petitioner
Isa resident.
2. Whose Name May Be Changed v
The petitionmay be used tochange your name and to obtain a court order recognizing a change of gender and for issuance of a
If you were born in California, you may file the order
new‘birth certificate, if you are 18 or older. (Minors must use form NC—500.)
with 'the State Registrar and obtain é new birth certificate.
3. What Forms Are Required _
You need'an and two copies of each of the following documents:
original
a. Change of Name, Recognition of Change of Gender, and Issuance of New Birth Certificate (form NC-200)
Petition for
b. Name and Information About the Person Whose Name Is to Be Changed (Attachment to Petition) (form NC-1 10)
c. Order to Show Cause for Change of Name to Conform to Gender Identity (form NC—125/NC-225)
d . Decree Changing Name and Order Recognizing Change of Gender Identity and for Issuance of New Birth Certificate
(formNC--230)
e. Case.
.’Civ_il G&vefékfat &r§ CM-010)
4. Filingand FilingFee
Prepare an original Civil Case Cover Sheet(form CM-010). File the original petition and Civil Case Cover Sheetwith the clerk of
the court and obtain two filed-endorsed copies of the petition. A filing fee will be charged unless you qualify for a fee waiver. (1f you
Request to Waive Court Fees (form FW-001) and Information Sheet on Waiver of Superior
want to apply for a fee waiver, see
Court Fees and Costs (form FW-OO1—INFO).)
5. Filing theOrder to Show Cause
Ask the Show Cause,
court clerk to obtain a judge's signature on the Order to then file the original
order inthe clerk’s office and
obtain filed-endorsed copies of the order.
6. Domestic Violence Confidentiality Program
In cases where the petitioner is a participant'In the state address confidentiality program (Safe at Home), the petition, the order to
show cause, and the decree should, instead of giving the proposed name, indicate that the name is confidential
and on file with the
Secretary of State. See Information Sheet for Name Change Proceedings Under Address Confidentiality Program (Safe at Home)
(form NC-400- lN.FO)
7. Court Hearing
If no objections are A hearing
filed, the court will grant the petition without a hearing. date willbe setiftimely objections havebeen
filed.Ifthereis a hearing, you be sent a notice by the
will court.You may also check with the court after the deadline to see
ifa
hearing date has been set.Bring copies of all documentsto the hearing.
If name and gender change
the judge grants the petition,
the judgewillsign the original decree.
8. Birth Certificate
If you were born in California, to obtain a new birth certificate reflecting the change of gender, file a certified copy of the order within
30 days with the Secretaryof State and the State Registrar and pay the applicable fees. You may write or contact the State
Registrarat:
California Department of Public Health
Vital Records — MS 5103
P.O. Box 997410
Sacramento, CA 95899-7410
Phone: 916—445-2684
Website: www.cdph.ca.gov
Local courtsmay supplement these instructions. Check with the court to determine whether supplemental information is available.
may provide you with additional written information identifying the department that handles name and
For instance, the court
gender change petitions, and the times when petitions are heard.
NC-ZUOIRev-Septemberww PETITION FOR CHANGE 0F NAME, RECOGNITION 0F CHANGE Paeezm
0F GENDER, AND ISSUANCE 0F NEw BIRTH CERTIFICATE
For your protection and privacy, please press the Clear “““““““““
_
r
This Form button after you have printed the form. ’Printt‘hisfovrm Save this form 5
I 1l
NC-110
PETITION OF (Name
M
ofpetitioner orpetitioners): (‘e - CASE NUMBER:
Dd, K0 Fa Dom?“ Auxi- FOR CHANGE 0F NAME
NAME AND INFORMATION ABOUT THE PERSON
WHOSE NAME IS TO BE CHANGED Attachment of
Attachment to Petition (form NC-1 00, form NC-200, or form NC-500)
(You must use a separate attachment for each person whose name is to be changed. pretitioner is a guardian of a minor, a
supplemental attachment, Declaration of Guardian (form NC-1 106), must also be completed and attached for each minor whose name
is to be changed.)
7.
b.
fl(1
)
Self
Present
E Other
name (specify): UoJROHL m“: EA
name
(Continued) Petitioner applies for a decree to change the of the following person:
(306+
(2) Proposed name (specify): Rmefim lexfifikfim “Q‘s"
0S / o $ / fifi§
(3) Born on (date
and presently E
orbirth):
under 18 years of age
t mam;
fi over 18 years of age
(4)
(5)
(6)
Born at (place ofbirth):
Sex (as stated on
Locum
E
original birth cenificate):
Current re/sidence address(street, city, county,
ale E
and zip code):
Female
‘
\67\ t: Em“ (30$ LA (Av: \NE f/ re smo' Crews (,M~\\\\5 C(A R'Hflo
c. Reason for name change (explain):
‘
To oomcorm m5 Mme om") (bewhr +0
MS‘Nye/way
d.
(1)
- self (4) E
E
whose name
Relationship of the petitioner to the person
Lu nearrelative
willbe changed:
(indicate relationship):
e.
(2)
(3) E parent
guardian
the person
If whose name
(5)
be changed
will
Other(specify):
isunder 18 years of age, provide the names and addresses, ifknown, of the
following persons:
(1) Parent (name): _
(address):
(2) Parent (name): (address):
(3) (On/yifneitherparent Near
is living) relatives(names, relationships, and addresses):
f. Ifthe person whose name be changed
will is18 years 0f age or older, that person must sign the following declaration:
DECLARATION
|
E
declare under penalty of perjury under the laws of the State of California that (check one) |am not E |am
under the
jail and (check one)
E |am not E
jurisdiction of the California Department of Corrections and Rehabilitation (in state prison or on parole) or in county
lam required to register as a sex offender under Penal Code section 290.
Date:
Dawn
7/ “/3033
(TYPE
00mm (406*
OR PRINT NAME OF PERSON WHOSE NAME
T0 BE CHANGED)
IS
'l'
’W
represented by an attorney, the attorney's signature follows):
(If petitioner is
WWW WHOSE NAME IS TO BE CHANGED)
(SIGNATURE OF PERSON
Date:
W
D
(TYPE0R PRINT NAME) (SIGNATURE 0F ATrORNEY)
(Each petitioner must sign this petition in the space provided below or, if additional pages are attached, at the end of the last
attachment.) declare under penalty of perjury under the laws of the State of California that the information in the foregoing petition is
|
true and corrct.
$0 3'3-
Date:
9“”
Date:
?l“
Um“ “W
0R PRINT NAME)
(rYPE
> Wham (SIGNATURE 0F PE'fihONER)‘
"""
>
0R PRINT NAME)
(TYPE (SIGNATURE 0F PETITIONER)
E ADD AmeIONAL SIGNATURE LINES FOR ADDITIONAL PETITIONERS
For{n_Adopled for Maqdatqry Use -
_
ATTACH MENT To
E sneNATURE 0F PETITIONERS FOLLows LAST ATrACHMENT
Code
page
1275
1on
of Civil Procedure, §
et seq.
WWW'”°”"S‘“'9°V
$15283?SSC‘F‘S‘SJSS'E‘Sszms] PETITION FOR CHANGE 0F NAME
For your protection and privacy, please press the Clear
> ,_ .x _‘
‘1
'
This Form button after you have printed the form. Print this form Save this form
l I I
Preview
NC-200 ATTORNEY OR PARTY WITHOUT ATTORNEY STATE BAR NUMBER; NAME: DQKMQ, DOJMU Alk$+ FIRM NAME: Bat“ A09 LIV“ AIM rb$ ‘9? STREET ADDRESS: I E CC¢ 59m CITY: LA STATE: ZIPCODE:q ‘3)? lo - TELEPHONENo.: S {q § us (4?? fl FAxNo.: E-MAIL ADDRESS: MQX‘KQ‘“ ‘1‘ . m¢§\@gflfi\\ aLON ‘ H L E ATTORNEY FOR (name): Ii “ Bro m( SUPERIOR COURT 0F c'eLIEORNIA, COUNTY 0F F re, 5 (\0 JUL 1 1 2022 STREET ADDRESS:H30 ions re Q&- MAILING ADDRESS: [l30 O $¥F€€¥ SUPERIOR COURT OF CALIFORNIA COUNTY OF FRESNO CITYAND CODE; ZIP F r Ls“ o I PX (‘3? }\ BY BRANCH NAME: R v; ' S; $\l (b\k (\\ mo‘ks Q DEPUTY PETITION 0F (name): i“ rQIZ— fngqun mm QA 9053‘ PETITION FOR CHANGE 0F NAME, RECOGNITION OF CHANGE OF GENDER, AND ISSUANCE OF NEW BIRTH CERTIFICATE CASE ”UM T2 ‘ u cc 0 2 0 5 9 Befor_e you comglete this petition, ou should read thg Instquctions for Filing on the ne_)gt pa_ge. You mujst answer all questions and c eck all boxes tha appjy to you on thls petgtlon. You must fl e thls petltlon m the superior court of the county where the person whose name Is to be changed resndes. 1. name): Petitioner (present DUAL“) *0. (Do. (\i QA Dubs 5r is 18 years old or older and a resident of this county. 2. decree that Petitioner requests that the court name petitioner's ischanged, inorder to conform to petitioner's gender identity. to g ’ (proposed name): M \’\ IQ, (k \Mo» “§(‘mx gw53< 3. a decree recognizing that the Petitioner requests gender petitioner's ischanged to: a. female. b. c. E E male. nonbinary. 4. new Petitioner requests that the court order that a be issued reflecting the gender and name changes sought by birth certificate this petition. 5. an order directing any interested persons to file written objections to show cause why Petitioner requests that the court issue name the petition for change of should not be granted. 6. insupport of this Petitioner provides the following information petition: a. The declaration below. b—f. The information contained inthe attachment (attach a completedcopy of the attachment Name and Information About the Person Whose Name ls toBe Changed (form NC-110)). I(present name): t ngqflrmmmu request for a change in I wm gender to (check one) 5‘, DECLARATION female E male E declare under penalty of perjury under the laws of the state of California that the nonbinary istoconform my legalgender tomy gender and identity isnot for any fraudulent purpose. Date: ?'I “I }O%g\ ‘ DMAOW (TYPEOR (\BM‘xek Qws* PRINT NAME OF PETITIONER) } (MLW/EM‘Q/VM (SIGNATURE 0F PETITIONER) on next page) (Instructions Page1of 2 Form AdoptedforMandamn/Use PETITION Judicial Council of California FOR CHANGE OF‘NAME, RECOGNITION 0F CHANGE Codevfcw" Procedurefiwfietsew: Health and Safety Code. §§ 103430, 103435 Nc-2oo[Rev.5eptember1,2o1a] OF GENDER, AND ISSUANCE OF NEW BIRTH CERTIFICATE www.courts-cagov NC-200 INSTRUCTIONS FOR FILING A PETITION FOR CHANGE 0F NAME AND GENDER 1. Where to File The change petition for ofname and gender must be filed'In the superior court'1n the county where the petitioner Isa resident. 2. Whose Name May Be Changed v The petitionmay be used tochange your name and to obtain a court order recognizing a change of gender and for issuance of a If you were born in California, you may file the order new‘birth certificate, if you are 18 or older. (Minors must use form NC—500.) with 'the State Registrar and obtain é new birth certificate. 3. What Forms Are Required _ You need'an and two copies of each of the following documents: original a. Change of Name, Recognition of Change of Gender, and Issuance of New Birth Certificate (form NC-200) Petition for b. Name and Information About the Person Whose Name Is to Be Changed (Attachment to Petition) (form NC-1 10) c. Order to Show Cause for Change of Name to Conform to Gender Identity (form NC—125/NC-225) d . Decree Changing Name and Order Recognizing Change of Gender Identity and for Issuance of New Birth Certificate (formNC--230) e. Case. .’Civ_il G&vefékfat &r§ CM-010) 4. Filingand FilingFee Prepare an original Civil Case Cover Sheet(form CM-010). File the original petition and Civil Case Cover Sheetwith the clerk of the court and obtain two filed-endorsed copies of the petition. A filing fee will be charged unless you qualify for a fee waiver. (1f you Request to Waive Court Fees (form FW-001) and Information Sheet on Waiver of Superior want to apply for a fee waiver, see Court Fees and Costs (form FW-OO1—INFO).) 5. Filing theOrder to Show Cause Ask the Show Cause, court clerk to obtain a judge's signature on the Order to then file the original order inthe clerk’s office and obtain filed-endorsed copies of the order. 6. Domestic Violence Confidentiality Program In cases where the petitioner is a participant'In the state address confidentiality program (Safe at Home), the petition, the order to show cause, and the decree should, instead of giving the proposed name, indicate that the name is confidential and on file with the Secretary of State. See Information Sheet for Name Change Proceedings Under Address Confidentiality Program (Safe at Home) (form NC-400- lN.FO) 7. Court Hearing If no objections are A hearing filed, the court will grant the petition without a hearing. date willbe setiftimely objections havebeen filed.Ifthereis a hearing, you be sent a notice by the will court.You may also check with the court after the deadline to see ifa hearing date has been set.Bring copies of all documentsto the hearing. If name and gender change the judge grants the petition, the judgewillsign the original decree. 8. Birth Certificate If you were born in California, to obtain a new birth certificate reflecting the change of gender, file a certified copy of the order within 30 days with the Secretaryof State and the State Registrar and pay the applicable fees. You may write or contact the State Registrarat: California Department of Public Health Vital Records — MS 5103 P.O. Box 997410 Sacramento, CA 95899-7410 Phone: 916—445-2684 Website: www.cdph.ca.gov Local courtsmay supplement these instructions. Check with the court to determine whether supplemental information is available. may provide you with additional written information identifying the department that handles name and For instance, the court gender change petitions, and the times when petitions are heard. NC-ZUOIRev-Septemberww PETITION FOR CHANGE 0F NAME, RECOGNITION 0F CHANGE Paeezm 0F GENDER, AND ISSUANCE 0F NEw BIRTH CERTIFICATE For your protection and privacy, please press the Clear “““““““““ _ r This Form button after you have printed the form. ’Printt‘hisfovrm Save this form 5 I 1l NC-110 PETITION OF (Name M ofpetitioner orpetitioners): (‘e - CASE NUMBER: Dd, K0 Fa Dom?“ Auxi- FOR CHANGE 0F NAME NAME AND INFORMATION ABOUT THE PERSON WHOSE NAME IS TO BE CHANGED Attachment of Attachment to Petition (form NC-1 00, form NC-200, or form NC-500) (You must use a separate attachment for each person whose name is to be changed. pretitioner is a guardian of a minor, a supplemental attachment, Declaration of Guardian (form NC-1 106), must also be completed and attached for each minor whose name is to be changed.) 7. b. fl(1 ) Self Present E Other name (specify): UoJROHL m“: EA name (Continued) Petitioner applies for a decree to change the of the following person: (306+ (2) Proposed name (specify): Rmefim lexfifikfim “Q‘s" 0S / o $ / fifi§ (3) Born on (date and presently E orbirth): under 18 years of age t mam; fi over 18 years of age (4) (5) (6) Born at (place ofbirth): Sex (as stated on Locum E original birth cenificate): Current re/sidence address(street, city, county, ale E and zip code): Female ‘ \67\ t: Em“ (30$ LA (Av: \NE f/ re smo' Crews (,M~\\\\5 C(A R'Hflo c. Reason for name change (explain): ‘ To oomcorm m5 Mme om") (bewhr +0 MS‘Nye/way d. (1) - self (4) E E whose name Relationship of the petitioner to the person Lu nearrelative willbe changed: (indicate relationship): e. (2) (3) E parent guardian the person If whose name (5) be changed will Other(specify): isunder 18 years of age, provide the names and addresses, ifknown, of the following persons: (1) Parent (name): _ (address): (2) Parent (name): (address): (3) (On/yifneitherparent Near is living) relatives(names, relationships, and addresses): f. Ifthe person whose name be changed will is18 years 0f age or older, that person must sign the following declaration: DECLARATION | E declare under penalty of perjury under the laws of the State of California that (check one) |am not E |am under the jail and (check one) E |am not E jurisdiction of the California Department of Corrections and Rehabilitation (in state prison or on parole) or in county lam required to register as a sex offender under Penal Code section 290. Date: Dawn 7/ “/3033 (TYPE 00mm (406* OR PRINT NAME OF PERSON WHOSE NAME T0 BE CHANGED) IS 'l' ’W represented by an attorney, the attorney's signature follows): (If petitioner is WWW WHOSE NAME IS TO BE CHANGED) (SIGNATURE OF PERSON Date: W D (TYPE0R PRINT NAME) (SIGNATURE 0F ATrORNEY) (Each petitioner must sign this petition in the space provided below or, if additional pages are attached, at the end of the last attachment.) declare under penalty of perjury under the laws of the State of California that the information in the foregoing petition is | true and corrct. $0 3'3- Date: 9“” Date: ?l“ Um“ “W 0R PRINT NAME) (rYPE > Wham (SIGNATURE 0F PE'fihONER)‘ """ > 0R PRINT NAME) (TYPE (SIGNATURE 0F PETITIONER) E ADD AmeIONAL SIGNATURE LINES FOR ADDITIONAL PETITIONERS For{n_Adopled for Maqdatqry Use - _ ATTACH MENT To E sneNATURE 0F PETITIONERS FOLLows LAST ATrACHMENT Code page 1275 1on of Civil Procedure, § et seq. WWW'”°”"S‘“'9°V $15283?SSC‘F‘S‘SJSS'E‘Sszms] PETITION FOR CHANGE 0F NAME For your protection and privacy, please press the Clear > ,_ .x _‘ ‘1 ' This Form button after you have printed the form. Print this form Save this form l I I