Request,Application: In the Matter of the Application of JENNIE LOUISE GORRES SKULSTAD OBO Minor for a Change of Name

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                                State of Minnesota                                                                                       District Court
                                                                         Judicial District:
                                                                                               '27"CV'23 '
 County
 Hennepin                                                                Court File Number:
                                                                         Case Type:             Name Change


[I  Interpreter Requested
Language

In the Matter of the Application of:
                                                                                                                                 .


                                                                                                                    {r J
                                                                                                                      4-.
        -                   -

Jennle               Loulse Gorres            Skulstad                                                     L_       {3'
First                      Middle                Last                                                               £33     :57


On Behalf of (current name of minor(s)):                                                                   a    L
                                                                                                                    '5";
                                                                                                                    :'j
                                                                                                                    :s 5;;
Carter               Hobart Gust             Skulstad                            Application for Nar_n_e Chafing:
First                      Middle                Last                                      of a Minor.      (D £2           _9


                                                                                                           0"
                                                                                         (Minn. Stat. §   259.10)
First                      Middle                Last




For a change of name to (new name of minor(s)):

Hobev                  Carter                 Skulstad
First                      Middle                Last



Fiist                      Middle                Last




The undersigned applicant states that:

1.      This application is made in good faith, without intent to defraud or mislead.

2.      The minor child(ren) whose name(s) are sought to be changed on this application have lived in the
        State   of Minnesota for at least six months immediately prior to the date of this application, and now
        live at:
        4715                                            Balsam Lane North
        No.                                                 Street
        Plymouth                                            Minnesota                  55442          Hennenin
        City/T own                                          State                      Zip                      County


3.      I am/we are the: (check one)

        X legal parent(s)




NAM202             State            ENG   Rev 1/20                  www.mncourts.gov/forms                                  Page     1   of 3
     D legal guardian
     D next of kin (specify):                              of the minor child(ren).



4.   The current name(s) of minor chi1d(ren) and date(s) of birth:

     Carter Hobart Gust Skulstad               —

                                                   Julv   19, 2007




5.   The name of the non-applicant parent(s):                         Hans Carl Skulstad                                                               ,



     and the address of the non—applicant parent(s) is/are: 4715 Balsam Lane North
                                                                                               No.                                          Street
     Plymouth                                              Minnesota                                      55442                  Hennepin
     City/T own                                                       State                               Zip                               County


          D The non-applicant parent is not listed on the birth certificate.
          D The non-applicant parent is not known, and his/her/their name(s) is/are not listed on the birth
                  certificate.




6.   Applicant requests to have the name(s) of the minor child(ren) changed to:

     Hobev Carter Skulstad




7.   The criminal history of the following minor children included in this application is:
     No criminal histon




     The following minor children included in this application have been convicted of a felony:

     No criminal history
     List name, date of offense, and state.   1f no criminal history, write   "No criminal history." If no felony convictions, write "No felony
     convictions"


8.   Legal description of lands in the State of Minnesota upon which the minor child(ren) has/have                                           a    claim,
     interest, or lien:       (Provide the legal description and attach additional pages                           if necessary)

     No lands or properties




NAM202        State             ENG            Rev 1/20                        www.mncourts.gov/forrns                                               Page 2 of 3
9.     Other:




                                                                   LLW
I declare under penalty            of peljury that everything I have stated in this document is true and
correct. Minn. Stat. § 358.116.


                  74AM
     gnature (Applfcant'),
                                                    14—513
                                                     Date         SignaturMCo-Applicant)
                                                                                                           "1/23
                                                                                                           l Date
                                                                  OR D There is only 1 Applicant

County and State where signed:                                    County and State where signed:
Humebin Coum'yl IMMnlSofi       _
                               I
                                                                  Hennepin County, Minnesota
           I

Name:          Jennie Louise Gorres Skulstad                      Name:      Hans Carl Skulstad
Address:             4715 Balsam Lane North                       Address:        4715 Balsam Lane North
City, State,                                                      City, State,
Zip:                 Plymouth, MN 55442                           Zip:            Plymouth, MN 55442
Telephone:           763-227—5528                                 Telephone:      952-393-6828
Email                                                             Email
address:           —jennie@centerforsportsandmind.com             address:       —hans@centerforsponsandmind.com




Cm-   tr                     tvig V'A               l/y/AB
Minor    Signature (14 years or older)               .Date         Minor Signature (14 years or older)      Date




NAM202          State        ENG         Rev 1/20            www.mncourts.gov/forms                        Page 3 of 3