On March 24, 2017 a
Complaint,Petition
was filed
involving a dispute between
Oropeza-Campos, Ivan,
and
for (43) Unlimited Other Petition (Not Spec)
in the District Court of San Mateo County.
Preview
NC-20C
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): STATE BAR NO;
i
NAME:Ivan Oropeza-Campos aka Ivan Oropeza
FIRM NAME: '
222‘Lux Ave, Apt. A
;
STREET ADDRESS:
CITY:South San Francisco STATE:CA 94080
ZIP CODE: FE .
B
415-424-1582
TELEPHONE N0.: FAXNo: . SAN MATEO
E-MAIL ADDRESS: CO
(In
ATTORNEYFOR (Name): Pro Per
MAR 2 4.
2017
SUPERIOR COURT OF CALIFORNIA, COUNTY OF San Mateo
STREET ADDRESS:400 County Center Clark on .
MAILING ADDRESS: 5
Redwood City, CA 94063
CITY AND ZIP CODE:
BRANCH NAME:
PETITION OF (Name):
Ivan Oropeza-Campos aka Ivan Oropeza
PETITION FOR CHANGE OF NAME AND GENDER fTNLCBT V
0 1 2 6 1
Before you complete this petition, you should read the Instructions for Filing a Petition for Change of Name and Gender on the next
page. You must answer all questions and check all boxes that apply to you on this petition. You must file this petition in the superior
court of the county where the person whose name is to be changed resides.
1. Petitioner (present name):Ivan Oropeza—Campos aka Ivan Oropeza of this county.
is a resident
2. Petitioner requests that the court decree that petitioner’s name is changed to (proposed name):
Ivette Oropeza—Campos
3. Petitioner requests a decree that the petitioner's gender is changed:
a. E] from male to female.
b. :1 from female to male.
4. An affidavit or a declaration of a physician documenting the gender change through clinically appropriate treatment as provided
(Declaration of Physician (form NC-210)
under Health and Safety Code sections 103425 and 103430 is attached to this petition.
may be used for this purpose.)
5. Petitioner requests that the court order that a new birth certificate be issued reflecting the gender and name changes sought by
this petition.
6. Petitioner requests that the court issue an order directing all interested persons to appear and show cause why the petition for
change of name should not be granted.
7. in support of this petition:
Petitioner provides the following information
a. The information contained in the physician‘s affidavit or declaration.
b—f. The information contained in the attachment (attach a completed copy of the attachmentName and Information About
the Person Whose Name Is to Be Changed (form NC-110)).
17—CIVQII1'2'5{"""“"‘ -
‘
PFNC
Petition for Name
430122
cm”
III/II IIIIIIIIIIIIII
'-
_
.
I/IIIIIII/III/I 44 (Instructions on next page) Page1on
I
Form Adopted for Mandatory Use Code of Civil Procedure. § 1275 et seq;
Judicial Council of California
PETITION FOR CHANGE OF NAME Health and Safety Code, 55 103430, 103435
NC-200 [Rev. July 1. 2014] AND GENDER www.caurtscagov
NC-11CI
PETITION OF (Name of petitioner orpetitioners):
Ivan Oropeza-Campos aka Ivan Oropeza CASE NUMBER:
FOR CHANGE OF NAME
I NAME AND INFORMATION ABOUT THE PERSON
I WHOSE NAME IS TO BE CHANGED Attachment 1 of I
‘
"
Attachment to Petition (form NC-100 or form NC-200)
(You must use al’separate attachment for each person whose name is to be changed. if petitioner is a guardian of a minor, a
supplemental attachment, Declaration of Guardian (form NC—1toG), must also be completed and attached for each minor whose name
'
is to be changed.)
7. (Continued) Petitioner applies for a decree to change the name of the following person:
b. III
(1)
Self 1:] Other
Present name (specify): Ivan Oropeza-Campos aka Ivan Oropeza
(2) Proposed name (specify): lvette Oropeza-Campos
(3) Born on (date of birth):
08/29/1982
(4)
and presently :1 under 18 years
Born at (place of birth):
Iguala,
of age I:]
Guerrero. Mexico
over 18 years of age
(5)
(6) Current residence address (street,
[I]
Sex (as stated on original birth certificate): Male [:1
and zip code):
city, county,
Female
222 Lux Ave, Apt. A. South San Francisco, CA 94080
0. Reason for name change (explain): This name better suits my identity.
d. Relationship of the petitioner to the person whose name will be changed:
(1) x self (4) C] near relative(indicate relationship):
(2) parent (5) C] Other (specify):
(3) [:1 guardian
e. {If the person whose name will be changed is under 18 years of age, provide the names and addresses,if known, of the
following persons:
(1) Father (name): (address):
(2) Mother (name): (address):
(3) (Only if neither parent is living) Near relatives (names, relationships,
and addresses):
rm
lfthe person whose name will be changed is 18 years of age or older, that person must sign the following declaration:
DECLARATION
I
[:1
declare under penalty of perjury under the laws of the State of California that I am not
E]
jurisdiction of the California Department of Corrections (in state prison or on parole) and I
[:I
am not
Iam
[:1
under the
Iam
required to register as a sex offender under Penal Code section 290.
Date: 03/01/2017
Ivan Oropeza-Campos aka Ivan Oropeza } NOVA Ofogc’m COM/\Ims
(TYPE OR PRINT NAME OF PERSON WHOSE NAME Is To BE CHANGED) (SIGNATURE OF PERSON WHOSE NAME Is To BE CHANGED)
(If petitioner is represented by an attorney, the attorney's signature follows):
Date:
):
(TYPE OR PRINT NAME) (SIGNATURE OF ATTORNEY)
(Each petitioner must sign this petition in the space provided below or, if additional pages are attached, at the end of the last
attachment.) Ideclare under penalty of perjury under the laws of the State of California that the information in the foregoing petition is
true and correct.
Date:
'
03/01/2017
Ivan Oropeza-Campos aka Ivan Oropeza
(TYPE OR PRINT NAME)
' NO!“ 0(05CZ9x CGMPCLS
(SIGNATURE OF PETITIONER)
Date:
(TYPE OR PRINT NAME) (SIGNATURE OF PETITIONER)
|:| ADD ADDITIONAL SIGNATURE LINES FOR ADDITIONAL PETITIONERS
Form Adopted for Mandatory Use
E] SIGNATURE OF PETITIONERS FOLLOWS LAST ATTACHMENT
Judicial Council of California
ATTAC HMENT To Code of Civil Procedure. § 1275 et seq.
NC-110[Rev.July1.2014] PETITION FOR CHANGE OF NAME
NC-210/NC-31D
_ PETITION OF (Name): '
CASE NUMBER:
Ivan Oropeza-Campos aka Ivan Oropeza
DECLARATION OF PHYSICIAN
Page [— of 2
'I
DOCUMENTING CHANGE OF GENDER THROUGH CLINICALLY APPROPRIATE TREATMENT
UNDER HEALTH AND SAFETY CODE SECTIONS 103425 AND 103430
Attachment to Petition for Change of Name and Gender (form NC-200) or Petition for Change of Gender and Issuance of New Birth
Certificate (form NC——300)
PLEASE SEE ATTACHED
Ideclare under penalty of perjury under the laws of the State of California that the information In the foregoing declaration
Istrue
and correct.
Date:
-
PLEASE SEE ATTACHED
(TYPE OR PRINT NAME OF PHYSICIAN) (SIGNATURE OF PHYSICIAN)
Page 1 of1
Form Approved for Optional Use
DECLARATION
Judicial Council of California OF PHYSICIAN—ATTACHMENT To PETITION HealthandSa'etvcode 55103425 103430
103435.103440
NC-210/NC-310 [Rev. January 1. 2012](Change of Name and Gender/Change of Gender) www. courts. ca. gov
Medical Clinic
"'95::355‘x 222 West 39th Ave
S \‘
COUNTYOFSAN MATEQ San Mateo, CA 94403
(650) 573-3982
HEALTH SYSTEM
Date: February 21, 2017
IVAN OROPEZA-CAMPOS:
222 LUKS-A AVENUE
SOUTH SAN FRANCISCO,CA,94080
Re: IVAN OROPEZA—CAMPOS:
MR #2 1180829
This individual is undergoing hormonal therapy as a component of gender transition from male to
female. This letter documents that this treatment is under my care
Thank you,
Dr. Bradd Silver
222 West 39th Ave
San Mateo, CA 94403
(650) 573-3982
Document Filed Date
March 24, 2017
Case Filing Date
March 24, 2017
Category
(43) Unlimited Other Petition (Not Spec)
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NC-20C ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): STATE BAR NO; i NAME:Ivan Oropeza-Campos aka Ivan Oropeza FIRM NAME: ' 222‘Lux Ave, Apt. A ; STREET ADDRESS: CITY:South San Francisco STATE:CA 94080 ZIP CODE: FE . B 415-424-1582 TELEPHONE N0.: FAXNo: . SAN MATEO E-MAIL ADDRESS: CO (In ATTORNEYFOR (Name): Pro Per MAR 2 4. 2017 SUPERIOR COURT OF CALIFORNIA, COUNTY OF San Mateo STREET ADDRESS:400 County Center Clark on . MAILING ADDRESS: 5 Redwood City, CA 94063 CITY AND ZIP CODE: BRANCH NAME: PETITION OF (Name): Ivan Oropeza-Campos aka Ivan Oropeza PETITION FOR CHANGE OF NAME AND GENDER fTNLCBT V 0 1 2 6 1 Before you complete this petition, you should read the Instructions for Filing a Petition for Change of Name and Gender on the next page. You must answer all questions and check all boxes that apply to you on this petition. You must file this petition in the superior court of the county where the person whose name is to be changed resides. 1. Petitioner (present name):Ivan Oropeza—Campos aka Ivan Oropeza of this county. is a resident 2. Petitioner requests that the court decree that petitioner’s name is changed to (proposed name): Ivette Oropeza—Campos 3. Petitioner requests a decree that the petitioner's gender is changed: a. E] from male to female. b. :1 from female to male. 4. An affidavit or a declaration of a physician documenting the gender change through clinically appropriate treatment as provided (Declaration of Physician (form NC-210) under Health and Safety Code sections 103425 and 103430 is attached to this petition. may be used for this purpose.) 5. Petitioner requests that the court order that a new birth certificate be issued reflecting the gender and name changes sought by this petition. 6. Petitioner requests that the court issue an order directing all interested persons to appear and show cause why the petition for change of name should not be granted. 7. in support of this petition: Petitioner provides the following information a. The information contained in the physician‘s affidavit or declaration. b—f. The information contained in the attachment (attach a completed copy of the attachmentName and Information About the Person Whose Name Is to Be Changed (form NC-110)). 17—CIVQII1'2'5{"""“"‘ - ‘ PFNC Petition for Name 430122 cm” III/II IIIIIIIIIIIIII '- _ . I/IIIIIII/III/I 44 (Instructions on next page) Page1on I Form Adopted for Mandatory Use Code of Civil Procedure. § 1275 et seq; Judicial Council of California PETITION FOR CHANGE OF NAME Health and Safety Code, 55 103430, 103435 NC-200 [Rev. July 1. 2014] AND GENDER www.caurtscagov NC-11CI PETITION OF (Name of petitioner orpetitioners): Ivan Oropeza-Campos aka Ivan Oropeza CASE NUMBER: FOR CHANGE OF NAME I NAME AND INFORMATION ABOUT THE PERSON I WHOSE NAME IS TO BE CHANGED Attachment 1 of I ‘ " Attachment to Petition (form NC-100 or form NC-200) (You must use al’separate attachment for each person whose name is to be changed. if petitioner is a guardian of a minor, a supplemental attachment, Declaration of Guardian (form NC—1toG), must also be completed and attached for each minor whose name ' is to be changed.) 7. (Continued) Petitioner applies for a decree to change the name of the following person: b. III (1) Self 1:] Other Present name (specify): Ivan Oropeza-Campos aka Ivan Oropeza (2) Proposed name (specify): lvette Oropeza-Campos (3) Born on (date of birth): 08/29/1982 (4) and presently :1 under 18 years Born at (place of birth): Iguala, of age I:] Guerrero. Mexico over 18 years of age (5) (6) Current residence address (street, [I] Sex (as stated on original birth certificate): Male [:1 and zip code): city, county, Female 222 Lux Ave, Apt. A. South San Francisco, CA 94080 0. Reason for name change (explain): This name better suits my identity. d. Relationship of the petitioner to the person whose name will be changed: (1) x self (4) C] near relative(indicate relationship): (2) parent (5) C] Other (specify): (3) [:1 guardian e. {If the person whose name will be changed is under 18 years of age, provide the names and addresses,if known, of the following persons: (1) Father (name): (address): (2) Mother (name): (address): (3) (Only if neither parent is living) Near relatives (names, relationships, and addresses): rm lfthe person whose name will be changed is 18 years of age or older, that person must sign the following declaration: DECLARATION I [:1 declare under penalty of perjury under the laws of the State of California that I am not E] jurisdiction of the California Department of Corrections (in state prison or on parole) and I [:I am not Iam [:1 under the Iam required to register as a sex offender under Penal Code section 290. Date: 03/01/2017 Ivan Oropeza-Campos aka Ivan Oropeza } NOVA Ofogc’m COM/\Ims (TYPE OR PRINT NAME OF PERSON WHOSE NAME Is To BE CHANGED) (SIGNATURE OF PERSON WHOSE NAME Is To BE CHANGED) (If petitioner is represented by an attorney, the attorney's signature follows): Date: ): (TYPE OR PRINT NAME) (SIGNATURE OF ATTORNEY) (Each petitioner must sign this petition in the space provided below or, if additional pages are attached, at the end of the last attachment.) Ideclare under penalty of perjury under the laws of the State of California that the information in the foregoing petition is true and correct. Date: ' 03/01/2017 Ivan Oropeza-Campos aka Ivan Oropeza (TYPE OR PRINT NAME) ' NO!“ 0(05CZ9x CGMPCLS (SIGNATURE OF PETITIONER) Date: (TYPE OR PRINT NAME) (SIGNATURE OF PETITIONER) |:| ADD ADDITIONAL SIGNATURE LINES FOR ADDITIONAL PETITIONERS Form Adopted for Mandatory Use E] SIGNATURE OF PETITIONERS FOLLOWS LAST ATTACHMENT Judicial Council of California ATTAC HMENT To Code of Civil Procedure. § 1275 et seq. NC-110[Rev.July1.2014] PETITION FOR CHANGE OF NAME NC-210/NC-31D _ PETITION OF (Name): ' CASE NUMBER: Ivan Oropeza-Campos aka Ivan Oropeza DECLARATION OF PHYSICIAN Page [— of 2 'I DOCUMENTING CHANGE OF GENDER THROUGH CLINICALLY APPROPRIATE TREATMENT UNDER HEALTH AND SAFETY CODE SECTIONS 103425 AND 103430 Attachment to Petition for Change of Name and Gender (form NC-200) or Petition for Change of Gender and Issuance of New Birth Certificate (form NC——300) PLEASE SEE ATTACHED Ideclare under penalty of perjury under the laws of the State of California that the information In the foregoing declaration Istrue and correct. Date: - PLEASE SEE ATTACHED (TYPE OR PRINT NAME OF PHYSICIAN) (SIGNATURE OF PHYSICIAN) Page 1 of1 Form Approved for Optional Use DECLARATION Judicial Council of California OF PHYSICIAN—ATTACHMENT To PETITION HealthandSa'etvcode 55103425 103430 103435.103440 NC-210/NC-310 [Rev. January 1. 2012](Change of Name and Gender/Change of Gender) www. courts. ca. gov Medical Clinic "'95::355‘x 222 West 39th Ave S \‘ COUNTYOFSAN MATEQ San Mateo, CA 94403 (650) 573-3982 HEALTH SYSTEM Date: February 21, 2017 IVAN OROPEZA-CAMPOS: 222 LUKS-A AVENUE SOUTH SAN FRANCISCO,CA,94080 Re: IVAN OROPEZA—CAMPOS: MR #2 1180829 This individual is undergoing hormonal therapy as a component of gender transition from male to female. This letter documents that this treatment is under my care Thank you, Dr. Bradd Silver 222 West 39th Ave San Mateo, CA 94403 (650) 573-3982