Document for In the Matter of the Application of Kathryn Emily Hankey for a Change of Name

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                                State of Minnesota                                                                                          District Court
 County                                                                     Judicial District:          Hyurfl
                                                                            Court File Number:        2'3'CV'7/3 401%
       Hem/\CPin                                                            Case Type:                  Name Change

In the Matter of:


Kmwn
First
       Emi lg
      Middle
                                   Hafllfi'i
                                      Last
                                                                            Order Granting Name Change
                                                                                 And Other Relief
For a change of name to:                                           (Minn. Stat. § 259.10, § 144.218, and § 144.2181)

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First             Middle U                   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: :l'Ol N Lad,           g;   ,
                                                                            8121b 3| lg     m'flm                SSL'lO            l

                          '                     Street                      City/Town              eggpl\mN
                                                                                                     tate        Zip
       in                                                County.
             l'lCXWlQl?\Y\
3. Name       of applicant and date of birth:
                                                    MYfin m\ "j                            \'lCMWJIj     (I?! 05 A4015
4. Name       of spouse and date of birth:      [33! (MIL WWII!—                 RSCW
       This application El does N does not include spouse.

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




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




NAM107         State     ENG        Rev 08/14                  www.mncourts.gov/forms                           Page   1   of 3
6.   This applicant requests:
        To have his/her name changed to         Kowwn Emflg 850m—
     D To have his/her name changed             on birth records created or maintained by the Minnesota

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

         Department of Health to
     D 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    D former name D former sex.
     D To have the name of his/her spouse changed to
     D To have the name(s) of his/her child (ren) changed to




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


     AND D Proper notice has been given to the prosecuting authority and Minnesota Attorney General
     AND D 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.)
     D Applicant
     D Spouse
     D Child (ren)



9.   Other:




The application is granted and IT IS ORDERED that:

D The legal name of the Applicant shall be

D The legal name of the      spouse shall be
NAM107        State    ENG         Rev 08/14             www.mncounsgov/fonns                     Page 2 of 3
D The legal names of the minor child (ren) shall be




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


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




D 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.

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

D shall reflect the Applicant's current legal name of

D shall reflect the sex designation of

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

U Other



Dated:
                                                        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.

NAM107        State       ENG       Rev 08/14           www.mncourts.govlfonns                Page 3 of 3