Preview
NC-100
STATE BAR
ATTORNEY OR PARTY WITHOUTATTORNEY (Name, State Bar number, ard address
NO'AME
Nataly Salazar
FIRM NAMEN/A
s~REE~ADDREss 187 Dumbarton Avenue
PILED
ciTY Redwood City sTATE CA zip coDE94063
TELEPHQNE No 650-716-9963 FAX NO
MWEC COU~
E-MAILADDRESS
ATTORNEY FOR (Name) g
SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN MATEO
PR y 020l
sTREE~ADDREss 400 County Center
I
MAILINGADDREss 400 County Center
f QOUftt
cITY AND zIP coDE
Redwood City, CA 94063-1655
BRANcHNAME Southern Branch
PETITION OF (Name of eachpetitioner)
Nataly Salazar
CASE NUMBER
PETITION FOR CHANGE OF NAIIE
c l v583319
Before you completethis petition, you should
read for Fihng a Petition for Change
the Instructions of Name on the next pageYou must
answer all questions
and check all boxes court of the county
You must file this petition m the supenor
that apply to you on this petition
where the personwhose name is to be changedresides
1 PetitiOner(name) Nataly Salazar resides in this county
2 the following name
that the court decree
Petitioner requests changes (list every namethat you are
seeking to change)
Present name ~Proosed name
a Nataly Salazar changed toNataly Salazar Barragan
changed to
changed to
changed to
~ Continued
Attachment
(ifyou are
2)
seeking to change additional names,you must prepare it to this petition as
a list and attach
3 that the court issue
Petitioner requests an order directing all interested
persons to appearand show cause why this petition for
change of name of the personsidentified in item 2 should
not be granted
4 The number of persons under 18 yearsof age whose names are to be changedis (specify)
5 If this petition requests
thechange of name of any person or personsunder 18 years,this requestis beingmade by
a ~ both parents
b
c ~
~
~x motheronly
father only
d
e
f
~
~
near relative
guardian
(name
(name)
other(specify)
and relationship)
6
7
~
For each person whose
to conform petitioner's
This petition seeks
name is to be changed,
name to his or her gender
identity
a completed
petitioner provides the following information (you must attach copy of
the attachment Name and Information About thePerson Whose Name ls to Be Changed (form NC-110) for eachperson identified in
item 2)
a The number of attachments included in this petition is (specify number)
b-f (Attachment page or pages)
(Instructions on next page) Page1of2
Form Adopted for Mandatory Use
PETITION FOR CHANGE OF NAIIE g 12(5 et seq
Code of Civil Procedure
Judiaal Counml of California www cour(sea gov
NC-100 [Rev July 1, 2014) (Change of Name)
INSTRUCTIONS FOR FILING A PETITION
1 Where to File FOR CHANGE OF NAME
of name
The petition for change court of the county where
must be filed in the supenor the personwhose name is to be changed
presentlylives
2 Whose Name IIay Be Changed
The petition may be used to change one'sown name and, under certaincircumstances,the names of others under
(e g, children
18 yearsof age)
3 Confidentiality of CertainNames
In casesin which the petitioner is a participant
in the Secretaryof State's
address confidentiality program
(Safe at Home),
petitioner'scurrentandproposednamesmay bekeptconfidential (Code Civ Proc, $ 1277(b) ) See Information SheetforName
Change Proceedings Under Address Confidentiality Program
(Safe at Home) (form NC-400-INFO) for additionalinstructions
4 What Forms Are Required
Prepare an onginal andtwo copies of eachof the following documents
a Petition for Changeof Name (form NC-100)
b Name and Information About the Person Whose Name Is to Be Changed (Attachment to Petition) (form NC-110) (attach
as
many copies as necessary)
c Order to Show Cause for Change of Name (form NC-120)
d Decree Changing Name (form NC-130 or, for guardians,
form NC-130G)
a guardian
In addition, must prepare and attach a Declarationof Guardian (Supplemental Attachment to Petition) (form NC-110G)
for each child whosename is to be changed
5 Ffhng and Filing Fee
Prepare anonginal Ciwl Case Cover Sheet (form CM-010) File the onginal Ciwl Case
petition and Cover Sheet with the clerk of
the court andobtain two filed-endorsedcopies A filing fee will be charged
of the petition unlessyou qualify for a fee waiver
(If you
want to apply for a fee waiver,
see Application for Waiver of Court Fees
and Costs (form FW-001), Information Sheet on Waiver of
Court Feesand Costs (form FW-001-INFO), and Order on Application for Waiver of Court Fees
and Costs (form FW-003)
6 Requesting a Court Hearing Date and Obtaming the Order to Show Cause
You should requesta date for theheanng on the Order to Show Cause six weeks
at least Take the completed
in the future form to
the clerk's office
The clerk will prowde the heanng
date and location, officer's signature,
obtain the)udicial file the onginal,
and give
you a copy
7 Publishing the Order to Show Cause
In most cases,a copy of theOrder to Show Cause must be pubfished in a local newspaperof general a week for at
circulation once
leastfour consecutive weeks before the dateof theheanng The petitioner selects
the newspaper from among those newspapers
orders
legally qualified to publish and notices The newspaper used must file aProof of Pubfication with the supenor
court before
the heanng If no newspaper of generalcirculation is published
in thecounty,the court may order theOrder to Show Cause to be
postedby the clerk do not have
But petitioners to publish the order if they are
seeking to change a name to conform to a change
of genderidentity or are
participants Witness
in (1) the State Program or (2) the addressconfidentiality program
and the petition
allegesthat they are
(a) petitioning to avoid domestic
wolence, or (b) petitioning to avoid stalking,
or (c) a victim of sexual
assaultor
petitioning on behalf of one
8 Name Change for Children
a If a petitioning parent
is requestingthe name change for a child under
18 years of age,and one of the parents,
if living, does
not
to the
Ioin in consenting name change, the petitioning parent
must have a copy of theOrder to Show Cause or notice of the time
and place of theheanng served on the nonconsenting parent Serwce must be made at least30 days prior to the
hearing
under Code of Ciwl Proceduresections413 10,414 10, 415 10,or 415 40
b If the nonconsentingparentresides in California, the order or notice must be personally
served on the nonconsenting parent
The petitioning parent
cannot personallyserve this document
c If the
nonconsenting parentresides outsideCalifornia, he or she
may be served by sending a copy of the order or notice by
first-class
mail, postage prepaid,returnreceiptrequested
d If a petition to change
thename of a child has
been filed by a guardian,
the guardian must (1) prowde notice of the heanng
to
any liwng parentof thechild by personal
serwce at least
30 days before theheanng, or (2) if either or both
parents are
deceased or cannotbe located,serve notice of the
heanng on the child's grandparents,
if living, not less
than 30 days before
theheanng under Code of Civil Procedure
sections413 10, 41410, 415 10, or 415 40
If you haveserved a parent or grandparents, Proof of Service
file a copy of the completed of Order to Show Cause (form NC-121)
with the court before
the heanng
9 Court Hearing
If no wnttenobiectionis filed at least two court days
beforethe heanng, the court may grant the
petition without a heanngCheck
with the court to find out if a heanng
will be
held if thereis a heanng,bnng copies of all documentsto the heanng If the)udge
grants the petition, the )udge will sign the onginal decree
10 Ifyou want to amend a birth certificate to show the
name change, you should contact the following office
California Department of Public Health, Vital Records-
MS 5103, P 0 Box 997410, Sacramento, CA 95899-7410
Phone. 916~5-2684, Website www cdph.ca.gov
Local courtsmay supplement these instructionsCheck with thecourt to determinewhether supplemental information is available
For instance,thecourt may prowde you with additional wntten
information identifying the department
that handlesname change
the times when
petitions, petitions
are heard, and the newspapers that may be used to pubfish theOrder to Show Cause
NC-100 [Rev July1,2014I Page 2 of 2
PETITION FOR CHANGE OF NAME
(Change of Name)
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fha C QBI]
This Farm button 0ftaf yau'halva
prlfftad th0 form.] ~
Print this form I ~
Save this form (
~lea'r'this'form I
NC-110
PETITIObl OF (Name of petit(oner or pebtioners) CASE NUMBER
Nataly balazar
FOR CHANGE OF NAME
NAME AND INFORMATION ABOUT THE PERSON
WHOSE NAME IS TO BE CHANGED Attachment of
Attachment to Petition (form NC-100 or form NC-200)
(You must use a separate attachment for eachperson whose name is to be changed lfpetiboner is a guardian
of a minor, a
supplemental attachment, Declarationof Guardian (form NC-710G), must also be completed and attached for each minor whose name
is to be changed)
7
b ~
(Continued)
(1)
Self
PreSent
~
name
Other
for a decree
Petitioner applies
(SpeCify)
to change
Nataly Salazar
the name of the following person
(2) PrOpOSed name (SpeCify) Nataly Salazar Barragan
(3) Born
and
on (date
presently ~
ofbirth) 1/23/1996
under 18 years of age ~x over 18 years of age
(4)
(5)
(6)
Sex
of birth)
Born at (Place
(as stated
Los Angeles
~
on onginal birth certificate)
ChlyrP6)t residency
address Ireet, cp cougt)r
Male
gd zip code)
~x Female
c Reason for name change (explain)
lvly mother'slast namewa's never put on my birth certificate
d Relationship
(1)
~
~u self (4) ~
of the petitioner to the person
~
whose
near
name
relative
will be changed
(indicate relationship)
e
(2)
(3) ~ parent
guardian
If the person
whose name
(5) Other (specify)
will be changedis under 18 yearsof age,provide thenames and addresses, if known, of the
followingpersons
(1) Father(name) (address)
(2) Mother (name) (address)
(3) (Only ifneither parent
is liwng) Near relatives
(names, and addresses)
relationships,
If the
person whose name will bechanged is 18 yearsof age or older, that person
must sign the following declaratton
Ideclare under penalty
)unsdictionof the
of per)ury under the
California Department
DECLARATION
laws of the State
of Corrections(in state
pnson
~
of California that
or on parole)
I am
and
not
~x I
~
am not
I
~
am under the
I am
requiredto registerasa sex offender under Penal Code section290
Date 4rergots
I
Nataly Salazar
(TYPE OR PRINT NAME OF PERSON WHOSE NAME IS TO BE CHANGED) (SIGNATURE OF(ffERSON WHOSE NAME IS TO BE CHANGED)
V
(lfpetftionerisrepresented by an attorney, the attorney'ssignature follows):
Date
(TYPE OR PRINT NAME) (SIGNATURE OF ATTORNEY)
(Each petitioner must sign this petition m the space provided below or, ifadditional pages are attached,at the end of the last
affachment) I declareunder penaltyof pei)ury under the laws of the State
of California that the information in the foregoing
petition is
true andcorrect
Date 4r9201s
Nataly Salazar
(TYPE OR PRINT NAME)
t A%i4(d(I
Preview
NC-100 STATE BAR ATTORNEY OR PARTY WITHOUTATTORNEY (Name, State Bar number, ard address NO'AME Nataly Salazar FIRM NAMEN/A s~REE~ADDREss 187 Dumbarton Avenue PILED ciTY Redwood City sTATE CA zip coDE94063 TELEPHQNE No 650-716-9963 FAX NO MWEC COU~ E-MAILADDRESS ATTORNEY FOR (Name) g SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN MATEO PR y 020l sTREE~ADDREss 400 County Center I MAILINGADDREss 400 County Center f QOUftt cITY AND zIP coDE Redwood City, CA 94063-1655 BRANcHNAME Southern Branch PETITION OF (Name of eachpetitioner) Nataly Salazar CASE NUMBER PETITION FOR CHANGE OF NAIIE c l v583319 Before you completethis petition, you should read for Fihng a Petition for Change the Instructions of Name on the next pageYou must answer all questions and check all boxes court of the county You must file this petition m the supenor that apply to you on this petition where the personwhose name is to be changedresides 1 PetitiOner(name) Nataly Salazar resides in this county 2 the following name that the court decree Petitioner requests changes (list every namethat you are seeking to change) Present name ~Proosed name a Nataly Salazar changed toNataly Salazar Barragan changed to changed to changed to ~ Continued Attachment (ifyou are 2) seeking to change additional names,you must prepare it to this petition as a list and attach 3 that the court issue Petitioner requests an order directing all interested persons to appearand show cause why this petition for change of name of the personsidentified in item 2 should not be granted 4 The number of persons under 18 yearsof age whose names are to be changedis (specify) 5 If this petition requests thechange of name of any person or personsunder 18 years,this requestis beingmade by a ~ both parents b c ~ ~ ~x motheronly father only d e f ~ ~ near relative guardian (name (name) other(specify) and relationship) 6 7 ~ For each person whose to conform petitioner's This petition seeks name is to be changed, name to his or her gender identity a completed petitioner provides the following information (you must attach copy of the attachment Name and Information About thePerson Whose Name ls to Be Changed (form NC-110) for eachperson identified in item 2) a The number of attachments included in this petition is (specify number) b-f (Attachment page or pages) (Instructions on next page) Page1of2 Form Adopted for Mandatory Use PETITION FOR CHANGE OF NAIIE g 12(5 et seq Code of Civil Procedure Judiaal Counml of California www cour(sea gov NC-100 [Rev July 1, 2014) (Change of Name) INSTRUCTIONS FOR FILING A PETITION 1 Where to File FOR CHANGE OF NAME of name The petition for change court of the county where must be filed in the supenor the personwhose name is to be changed presentlylives 2 Whose Name IIay Be Changed The petition may be used to change one'sown name and, under certaincircumstances,the names of others under (e g, children 18 yearsof age) 3 Confidentiality of CertainNames In casesin which the petitioner is a participant in the Secretaryof State's address confidentiality program (Safe at Home), petitioner'scurrentandproposednamesmay bekeptconfidential (Code Civ Proc, $ 1277(b) ) See Information SheetforName Change Proceedings Under Address Confidentiality Program (Safe at Home) (form NC-400-INFO) for additionalinstructions 4 What Forms Are Required Prepare an onginal andtwo copies of eachof the following documents a Petition for Changeof Name (form NC-100) b Name and Information About the Person Whose Name Is to Be Changed (Attachment to Petition) (form NC-110) (attach as many copies as necessary) c Order to Show Cause for Change of Name (form NC-120) d Decree Changing Name (form NC-130 or, for guardians, form NC-130G) a guardian In addition, must prepare and attach a Declarationof Guardian (Supplemental Attachment to Petition) (form NC-110G) for each child whosename is to be changed 5 Ffhng and Filing Fee Prepare anonginal Ciwl Case Cover Sheet (form CM-010) File the onginal Ciwl Case petition and Cover Sheet with the clerk of the court andobtain two filed-endorsedcopies A filing fee will be charged of the petition unlessyou qualify for a fee waiver (If you want to apply for a fee waiver, see Application for Waiver of Court Fees and Costs (form FW-001), Information Sheet on Waiver of Court Feesand Costs (form FW-001-INFO), and Order on Application for Waiver of Court Fees and Costs (form FW-003) 6 Requesting a Court Hearing Date and Obtaming the Order to Show Cause You should requesta date for theheanng on the Order to Show Cause six weeks at least Take the completed in the future form to the clerk's office The clerk will prowde the heanng date and location, officer's signature, obtain the)udicial file the onginal, and give you a copy 7 Publishing the Order to Show Cause In most cases,a copy of theOrder to Show Cause must be pubfished in a local newspaperof general a week for at circulation once leastfour consecutive weeks before the dateof theheanng The petitioner selects the newspaper from among those newspapers orders legally qualified to publish and notices The newspaper used must file aProof of Pubfication with the supenor court before the heanng If no newspaper of generalcirculation is published in thecounty,the court may order theOrder to Show Cause to be postedby the clerk do not have But petitioners to publish the order if they are seeking to change a name to conform to a change of genderidentity or are participants Witness in (1) the State Program or (2) the addressconfidentiality program and the petition allegesthat they are (a) petitioning to avoid domestic wolence, or (b) petitioning to avoid stalking, or (c) a victim of sexual assaultor petitioning on behalf of one 8 Name Change for Children a If a petitioning parent is requestingthe name change for a child under 18 years of age,and one of the parents, if living, does not to the Ioin in consenting name change, the petitioning parent must have a copy of theOrder to Show Cause or notice of the time and place of theheanng served on the nonconsenting parent Serwce must be made at least30 days prior to the hearing under Code of Ciwl Proceduresections413 10,414 10, 415 10,or 415 40 b If the nonconsentingparentresides in California, the order or notice must be personally served on the nonconsenting parent The petitioning parent cannot personallyserve this document c If the nonconsenting parentresides outsideCalifornia, he or she may be served by sending a copy of the order or notice by first-class mail, postage prepaid,returnreceiptrequested d If a petition to change thename of a child has been filed by a guardian, the guardian must (1) prowde notice of the heanng to any liwng parentof thechild by personal serwce at least 30 days before theheanng, or (2) if either or both parents are deceased or cannotbe located,serve notice of the heanng on the child's grandparents, if living, not less than 30 days before theheanng under Code of Civil Procedure sections413 10, 41410, 415 10, or 415 40 If you haveserved a parent or grandparents, Proof of Service file a copy of the completed of Order to Show Cause (form NC-121) with the court before the heanng 9 Court Hearing If no wnttenobiectionis filed at least two court days beforethe heanng, the court may grant the petition without a heanngCheck with the court to find out if a heanng will be held if thereis a heanng,bnng copies of all documentsto the heanng If the)udge grants the petition, the )udge will sign the onginal decree 10 Ifyou want to amend a birth certificate to show the name change, you should contact the following office California Department of Public Health, Vital Records- MS 5103, P 0 Box 997410, Sacramento, CA 95899-7410 Phone. 916~5-2684, Website www cdph.ca.gov Local courtsmay supplement these instructionsCheck with thecourt to determinewhether supplemental information is available For instance,thecourt may prowde you with additional wntten information identifying the department that handlesname change the times when petitions, petitions are heard, and the newspapers that may be used to pubfish theOrder to Show Cause NC-100 [Rev July1,2014I Page 2 of 2 PETITION FOR CHANGE OF NAME (Change of Name) ~Fbiyaur prat0000A effd priv@ay, pl0000 Piaee fha C QBI] This Farm button 0ftaf yau'halva prlfftad th0 form.] ~ Print this form I ~ Save this form ( ~lea'r'this'form I NC-110 PETITIObl OF (Name of petit(oner or pebtioners) CASE NUMBER Nataly balazar FOR CHANGE OF NAME NAME AND INFORMATION ABOUT THE PERSON WHOSE NAME IS TO BE CHANGED Attachment of Attachment to Petition (form NC-100 or form NC-200) (You must use a separate attachment for eachperson whose name is to be changed lfpetiboner is a guardian of a minor, a supplemental attachment, Declarationof Guardian (form NC-710G), must also be completed and attached for each minor whose name is to be changed) 7 b ~ (Continued) (1) Self PreSent ~ name Other for a decree Petitioner applies (SpeCify) to change Nataly Salazar the name of the following person (2) PrOpOSed name (SpeCify) Nataly Salazar Barragan (3) Born and on (date presently ~ ofbirth) 1/23/1996 under 18 years of age ~x over 18 years of age (4) (5) (6) Sex of birth) Born at (Place (as stated Los Angeles ~ on onginal birth certificate) ChlyrP6)t residency address Ireet, cp cougt)r Male gd zip code) ~x Female c Reason for name change (explain) lvly mother'slast namewa's never put on my birth certificate d Relationship (1) ~ ~u self (4) ~ of the petitioner to the person ~ whose near name relative will be changed (indicate relationship) e (2) (3) ~ parent guardian If the person whose name (5) Other (specify) will be changedis under 18 yearsof age,provide thenames and addresses, if known, of the followingpersons (1) Father(name) (address) (2) Mother (name) (address) (3) (Only ifneither parent is liwng) Near relatives (names, and addresses) relationships, If the person whose name will bechanged is 18 yearsof age or older, that person must sign the following declaratton Ideclare under penalty )unsdictionof the of per)ury under the California Department DECLARATION laws of the State of Corrections(in state pnson ~ of California that or on parole) I am and not ~x I ~ am not I ~ am under the I am requiredto registerasa sex offender under Penal Code section290 Date 4rergots I Nataly Salazar (TYPE OR PRINT NAME OF PERSON WHOSE NAME IS TO BE CHANGED) (SIGNATURE OF(ffERSON WHOSE NAME IS TO BE CHANGED) V (lfpetftionerisrepresented by an attorney, the attorney'ssignature follows): Date (TYPE OR PRINT NAME) (SIGNATURE OF ATTORNEY) (Each petitioner must sign this petition m the space provided below or, ifadditional pages are attached,at the end of the last affachment) I declareunder penaltyof pei)ury under the laws of the State of California that the information in the foregoing petition is true andcorrect Date 4r9201s Nataly Salazar (TYPE OR PRINT NAME) t A%i4(d(I