Motion-Secondary: In the Matter of the Application of Lawrance Dwayne Skagen for a Change of Name

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                                27-CV-23-18220




  State of Minnesota                                                                                District Court
  County                                                               Judicial District:
       Hennepin                                                        Court File Number:
                                                                       Case Type:              Name Change

In the Matter of:
Lawrance       Dwayne          Skagen
First          Middle               Last
                                                                  Order Granting Name Change
                                                                       And Other Relief
For a change of name to:                                      (Minn. Stat. § 259.10, § 144.218, and § 144.2181)
Larry       Dwayne           Land
First          Middle                 Last




      The above entitled matter came on for hearing before the undersigned Judge on
_________________________ upon the Application for a Name Change and Other Relief. Upon the
Date
testimony and files, THE COURT FINDS the following:

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

2. The applicant(s) has/have lived in the State of Minnesota for at least six months preceding the filing

    of the application, and now live at:

                                           Street                 City/Town                 State       Zip
    in                                              County.

3. Name of applicant and date of birth:


4. Name of spouse and date of birth:

    This application  does  does not include spouse.

5. Name(s) of minor children and date(s) of birth:




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                                                   27-CV-23-18220




    This application does not include minor children listed above.
    This application includes the following minor children listed above:




6. This applicant requests:
    To have his/her name changed to


    To have his/her name changed on birth records created or maintained by the Minnesota
         Department of Health to


    To have his/her sex changed on birth records created or maintained by the Minnesota
         Department of Health to                               .
    To have the Minnesota Department of Health issue and register a replacement birth record. Applicant
         further requests the prior birth record be kept confidential and the replacement birth record not to
         include any reference to Applicant’s  former name  former sex.
    To have the name of his/her spouse changed to
    To have the name(s) of his/her child (ren) changed to




7. The applicant (and included spouse or child (ren))
    Has not been convicted of a felony in any state.
    Has been convicted of a felony as follows:


   AND  Proper notice has been given to the prosecuting authority and Minnesota Attorney General
   AND  No objection has been filed.

8. Legal description of lands in the State of Minnesota upon which the following have a claim, interest, or
   lien: (Provide the legal description and attach additional pages if necessary.)
    Applicant
    Spouse
    Child (ren)
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                                                   27-CV-23-18220




9. Other:

                                                                                                            .

The application is granted and IT IS ORDERED that:

 The legal name of the Applicant shall be

 The legal name of the spouse shall be
 The legal names of the minor child (ren) shall be




 The Minnesota Department of Health shall change the name on the birth record from
                                              to

 The Minnesota Department of Health shall change the sex on the birth record from                           to

                        .

 The Minnesota Department of Health shall issue and register a replacement birth record for the Applicant.
The prior birth record shall be confidential pursuant to Minn. Stat. § 13.02, subdivision 3, and shall not be
disclosed except pursuant to court order.

 The replacement birth record shall not include any reference to the Applicant’s
          former name
          former sex
and

 shall reflect the Applicant’s current legal name of

 shall reflect the sex designation of                                .                  .

         All persons having a criminal history who have been granted a name change by this
         court have a duty to report that name change to the Bureau of Criminal Apprehension
         within ten (10) days of this order.

 Other



Dated:
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                                              27-CV-23-18220




                                                  Judge of District Court



                                DUTY TO REPORT NAME CHANGE
                                      Minn. Stat. § 259.11B

If you have a criminal history and have changed your name, you have a duty to report your name change to
the Bureau of Criminal Apprehension located at 1430 East Maryland Avenue, St Paul, MN 55106, (651)793-
2400, within ten (10) days of this order. Failure to do so is a gross misdemeanor punishable by up to one
(1) year in prison and/or a fine of $3000.




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