On January 06, 2021 a
Request,Application
was filed
in the District Court of Butte County.
Preview
'
. ‘
.
'
. .
'
1775 Concord Ave
Superior Court of California 4'
Chico CA 95928
0f Civil
.
_
County BUtte ,
k
530—532-7009
BACKGROUND CHECK
Requested For Name Change Petition
'
To: Butte County Sheriffs Ofce
Fax:
'
_
(530)538-2099
I
From: ’
Superior Court of California, County of Butte
'
I
I'
-
1775 Concord ‘
Avenue'\
Chico, CA 95928
' '
Phone: (530)532—7009 .
.
,
(530) 532-7042
' .
Faxz. \
Date: January 06, 2021
'
Name: Ciara Larson Date of Birth: May 12, 2010
Court Case #: 21_cv0002'8
"
court Date: March 03, 2021 . I ~
\
L _
Subject: Request of the following background check pUrsuant code of Civil procedure..§ 1279.5(e): To
--
"determine whether or not the applicant is' under the jurisdiction oftthe Departmentof Corrections or is
required to register as a sex offender pursuant § 290 of the Penal code."
\
CLETS
Signature of person performing ch’eck
CJlS
Signature of person performing check
Please see attached petition with the name and information about the pers‘on requesting a name change.
'
D Nothing on le,
Signature
V '
D See attachedndings \
-
r
,II‘
Signature
\1
'NC-100
Anoauev on manly/mom moRNEY I
.
smas‘m’ NUMBER- .
'
NAME: Amber Larson
FRM NAME:
smear ADDRESS 325 W 3rd Ave
dry: Chico STATE:CA 95926
ZIP CODE: ~
Sugerior L‘oun ot California
oi Butte
i
TELEPHONE N0;530-354—0444 FAX N0;
EMAILADDREss: amberrudaine@gmaii.com County
ATTORNEY FOR (name): .
SUPEOR COURT OF CALIFORNIA, CQUNTY OF ,"
smaermoness; 1775 Concord Avenue
MAILING ADDRESS:
Chico, 95928
cmrAND zIP cooa-
‘
Butte County Superior Court ’
BRANQH NAME
I
o
PETITlON OF (name of each petitioner).
Amber Larson
-
PETmON FOR CHANGE or NAME @g 8-
(i wm Q Q
-
IL
I
Béfore you completé this petition. you should read the Instructions {or Filing a Petitlon for Change ofName
(form NC-100-INFO). You
must answer all questlons and check all boxes that apply to you on this petition. You must le
this petition in the superior court of the
county where the person whose name is to be changed resides. i I
I
‘
1. Petitioner (present name): Amber Larson ~
~
.
~
resides in this county.
I
2. Petitioner requests that the court decree the following name changes (list every name that you are seeking [to change):
'
re e e -
I
. .
Emgosed name'
.
a.‘Ciara Larson changed to Ciara Mae Moses
'
i ~
'b.
I I
changedto _|
‘
c.. ' '
changed to
I
'
d. changed to \
-
I
E Continued (ifyou are seeking to change additional names, you must prepare e list and attach it to this petition as
Attachment 2)
3. Petitioner requests that the court issue an order directing all interested persons to appear or le
objections to show cause why =
In item 2 should not be granted.
this petition for change of name of the persons identied' i
4. The number of persons under 18 years of age whose names are to be changed is (specify): 1
/
5. name of any personor persons un'der 18 years, this request-is being made by
If this petition requests the change of
E
.
‘
a. two parents.
E one parent.
-D
mopp-
near relative (name and relationship):
.E
r'
guardian (name):
D other (specify):
6. E This petition seeks to change name of (check one)
to conform to that person's gender identity.
E” petitioner .E (name):
7. For each person whose name is to be changed, petitioner provides the following information (you mus't attach a completed copy of
the attachment Name and lnfonnation About the Person Name ls to Be Changed (form NC—110) for each person identied In
Whose J
item 2): .
a. The number of attachmenm-included in this petition is (specify number):
1
b—f.(These are the items on the attached page or pag'es of form NC-1 10.) Page1of 1 I
‘ '
U”
wwgdgggmgmg .
PETITION FoR CHANGE 0F NAME WB°WPI°°°dmcgg§ggfgg
Nc-IaoIRav. September 1. 2018) (Change of Name)
'
Nc-‘HO
PETITION OF (Name'ofpetionerorpelioners):
Amber Larson I
~
CASE NUMBER-
.
FOR CHANGE 0F NAME "
‘
1
NAME AND INFORMATION ABOUT THE PERSON I
\_
WHOSE NAME IS To BE CHANGED I
Attachment 1 of 1
Attachment to Petition (form NC-100. form NC-ZOO or form NC-SOO)
(You must use a separate attachment for each person whose name is to be changed pretitioneris a guardian ofa minor, a
supplemental attachment, Declaration of Guardian (form NC-1 106), must also be completed and attached for minor whose name
~
is to be changed.) . each
-
7. (Continued) Petitioner applies for a decree to change the name of the following person:
K
‘
.
r. "
E E
I
b Self Other .
‘
=
.
-’
(1) Present name (specifw: Ciara Larson -
(2) Proposed name (specify): Ciara Mae Moses
'
, (3) Born on (date ofbiIth): May 12. 2010
‘
and presently E under 18 years of age D over 18 years'of age
‘
(4) Antioch. CA
Born at (place ofbirth):
.
" (5) E
Sex (as stated on original birth certicate): Male E] Female
(6) Currentresidence address and
(street, city, county, zip code): 325 W 3rd Avenue Chico, CA 95926
I
c. Reason for name change (explain): Father’s last name and middle name was not given upon birth.
d. Relationship of the petitioner to the person whose name wlll be changed:
'
x.
E
_
(1) self (4) near relativendicate relationship):
\
E
j I
‘
(2) x| parent (5) Other (specify):
"
(3) E guardian
_
e. lf the person whose name will be changed'Is under 18 years of age, provide the names and addresses, if known of the
following
-'
r
persons: .
(1) Parent (name). Amber Larson
'
(address). 325W. 3rd Ave Chico, CA 95926
I(2) Parent (name). Melvin Moses Jr. (address): deceased
(3) parentIs living) Near relatives (names, relationships, and addresses)
(Only ifneither \
f. lf the person whose name will be changed ls 18 years of age or older, that person must sign the following declaration:
’
DECLARATION
l E
declare under penalty of perjury under the laws of the State of California that (check one) l am not D l am
\’-
1
under the jurisdiction of the California Department of Corrections and Rehabilitation (in state prison or on parole) or in county
jail and.(check one)
'
D |am not
I
'
E
'
l am
I
required to register as a sex oender
'
under Penal Code section 290.
Date: ,
>
(TYPE 0R PRINT NAME OF PERSON WHOSE NAME B TO HE CHANGED) (SIGNATURE OF PERSON WHOSE NAME IS TO BE CHANGED)
(pretitroner is represented by an attorney, the attomey’s signature follows).
a
Date. l
(IYPE 0R PRINT NAME) (SIGNATURE or: ArrORIvEY)
(Each petitioner must sign this petition in the space provided below or, if additional pages are atMched, at the end of the last '
attachment.) Ideclare under penalty of perjury under the laws of the State of Cafomia
that the information'In the foregoing petition is
true and
.
Date:
Date: "
coneci"
1/5/2020
Amber Larson
I
a
(TYPE-0R PRINT NAME)
'
r
l
’ OM
\“ (SIGNATURE 0F
PETrnoNER)
b
(TYPE 0R PRINT NAME) (SIGNATURE 0F PETITIONER)
m
~
m ADD AbmeNAL SIGNATURE LINES FOR ADDmONAL PETTTIONERs SIGNATURE 0F PETITToNERs FbLLows LAST ATTACHMENT
‘
page10,1
Form Adopted In: Monastery Use
.
Judlml Council oi California
ATTAc H MENT To '
Code hIGImproceaure, § 1275 at seq.
wwwcomtsqgov
Nc-TIOIRevsepIamber 1,2018] ~
PETITION FOR CHANGE OF NAME
Document Filed Date
January 06, 2021
Case Filing Date
January 06, 2021
For full print and download access, please subscribe at https://www.trellis.law/.
Preview
' . ‘ . ' . . ' 1775 Concord Ave Superior Court of California 4' Chico CA 95928 0f Civil . _ County BUtte , k 530—532-7009 BACKGROUND CHECK Requested For Name Change Petition ' To: Butte County Sheriffs Ofce Fax: ' _ (530)538-2099 I From: ’ Superior Court of California, County of Butte ' I I' - 1775 Concord ‘ Avenue'\ Chico, CA 95928 ' ' Phone: (530)532—7009 . . , (530) 532-7042 ' . Faxz. \ Date: January 06, 2021 ' Name: Ciara Larson Date of Birth: May 12, 2010 Court Case #: 21_cv0002'8 " court Date: March 03, 2021 . I ~ \ L _ Subject: Request of the following background check pUrsuant code of Civil procedure..§ 1279.5(e): To -- "determine whether or not the applicant is' under the jurisdiction oftthe Departmentof Corrections or is required to register as a sex offender pursuant § 290 of the Penal code." \ CLETS Signature of person performing ch’eck CJlS Signature of person performing check Please see attached petition with the name and information about the pers‘on requesting a name change. ' D Nothing on le, Signature V ' D See attachedndings \ - r ,II‘ Signature \1 'NC-100 Anoauev on manly/mom moRNEY I . smas‘m’ NUMBER- . ' NAME: Amber Larson FRM NAME: smear ADDRESS 325 W 3rd Ave dry: Chico STATE:CA 95926 ZIP CODE: ~ Sugerior L‘oun ot California oi Butte i TELEPHONE N0;530-354—0444 FAX N0; EMAILADDREss: amberrudaine@gmaii.com County ATTORNEY FOR (name): . SUPEOR COURT OF CALIFORNIA, CQUNTY OF ," smaermoness; 1775 Concord Avenue MAILING ADDRESS: Chico, 95928 cmrAND zIP cooa- ‘ Butte County Superior Court ’ BRANQH NAME I o PETITlON OF (name of each petitioner). Amber Larson - PETmON FOR CHANGE or NAME @g 8- (i wm Q Q - IL I Béfore you completé this petition. you should read the Instructions {or Filing a Petitlon for Change ofName (form NC-100-INFO). You must answer all questlons and check all boxes that apply to you on this petition. You must le this petition in the superior court of the county where the person whose name is to be changed resides. i I I ‘ 1. Petitioner (present name): Amber Larson ~ ~ . ~ resides in this county. I 2. Petitioner requests that the court decree the following name changes (list every name that you are seeking [to change): ' re e e - I . . Emgosed name' . a.‘Ciara Larson changed to Ciara Mae Moses ' i ~ 'b. I I changedto _| ‘ c.. ' ' changed to I ' d. changed to \ - I E Continued (ifyou are seeking to change additional names, you must prepare e list and attach it to this petition as Attachment 2) 3. Petitioner requests that the court issue an order directing all interested persons to appear or le objections to show cause why = In item 2 should not be granted. this petition for change of name of the persons identied' i 4. The number of persons under 18 years of age whose names are to be changed is (specify): 1 / 5. name of any personor persons un'der 18 years, this request-is being made by If this petition requests the change of E . ‘ a. two parents. E one parent. -D mopp- near relative (name and relationship): .E r' guardian (name): D other (specify): 6. E This petition seeks to change name of (check one) to conform to that person's gender identity. E” petitioner .E (name): 7. For each person whose name is to be changed, petitioner provides the following information (you mus't attach a completed copy of the attachment Name and lnfonnation About the Person Name ls to Be Changed (form NC—110) for each person identied In Whose J item 2): . a. The number of attachmenm-included in this petition is (specify number): 1 b—f.(These are the items on the attached page or pag'es of form NC-1 10.) Page1of 1 I ‘ ' U” wwgdgggmgmg . PETITION FoR CHANGE 0F NAME WB°WPI°°°dmcgg§ggfgg Nc-IaoIRav. September 1. 2018) (Change of Name) ' Nc-‘HO PETITION OF (Name'ofpetionerorpelioners): Amber Larson I ~ CASE NUMBER- . FOR CHANGE 0F NAME " ‘ 1 NAME AND INFORMATION ABOUT THE PERSON I \_ WHOSE NAME IS To BE CHANGED I Attachment 1 of 1 Attachment to Petition (form NC-100. form NC-ZOO or form NC-SOO) (You must use a separate attachment for each person whose name is to be changed pretitioneris a guardian ofa minor, a supplemental attachment, Declaration of Guardian (form NC-1 106), must also be completed and attached for minor whose name ~ is to be changed.) . each - 7. (Continued) Petitioner applies for a decree to change the name of the following person: K ‘ . r. " E E I b Self Other . ‘ = . -’ (1) Present name (specifw: Ciara Larson - (2) Proposed name (specify): Ciara Mae Moses ' , (3) Born on (date ofbiIth): May 12. 2010 ‘ and presently E under 18 years of age D over 18 years'of age ‘ (4) Antioch. CA Born at (place ofbirth): . " (5) E Sex (as stated on original birth certicate): Male E] Female (6) Currentresidence address and (street, city, county, zip code): 325 W 3rd Avenue Chico, CA 95926 I c. Reason for name change (explain): Father’s last name and middle name was not given upon birth. d. Relationship of the petitioner to the person whose name wlll be changed: ' x. E _ (1) self (4) near relativendicate relationship): \ E j I ‘ (2) x| parent (5) Other (specify): " (3) E guardian _ e. lf the person whose name will be changed'Is under 18 years of age, provide the names and addresses, if known of the following -' r persons: . (1) Parent (name). Amber Larson ' (address). 325W. 3rd Ave Chico, CA 95926 I(2) Parent (name). Melvin Moses Jr. (address): deceased (3) parentIs living) Near relatives (names, relationships, and addresses) (Only ifneither \ f. lf the person whose name will be changed ls 18 years of age or older, that person must sign the following declaration: ’ DECLARATION l E declare under penalty of perjury under the laws of the State of California that (check one) l am not D l am \’- 1 under the jurisdiction of the California Department of Corrections and Rehabilitation (in state prison or on parole) or in county jail and.(check one) ' D |am not I ' E ' l am I required to register as a sex oender ' under Penal Code section 290. Date: , > (TYPE 0R PRINT NAME OF PERSON WHOSE NAME B TO HE CHANGED) (SIGNATURE OF PERSON WHOSE NAME IS TO BE CHANGED) (pretitroner is represented by an attorney, the attomey’s signature follows). a Date. l (IYPE 0R PRINT NAME) (SIGNATURE or: ArrORIvEY) (Each petitioner must sign this petition in the space provided below or, if additional pages are atMched, at the end of the last ' attachment.) Ideclare under penalty of perjury under the laws of the State of Cafomia that the information'In the foregoing petition is true and . Date: Date: " coneci" 1/5/2020 Amber Larson I a (TYPE-0R PRINT NAME) ' r l ’ OM \“ (SIGNATURE 0F PETrnoNER) b (TYPE 0R PRINT NAME) (SIGNATURE 0F PETITIONER) m ~ m ADD AbmeNAL SIGNATURE LINES FOR ADDmONAL PETTTIONERs SIGNATURE 0F PETITToNERs FbLLows LAST ATTACHMENT ‘ page10,1 Form Adopted In: Monastery Use . Judlml Council oi California ATTAc H MENT To ' Code hIGImproceaure, § 1275 at seq. wwwcomtsqgov Nc-TIOIRevsepIamber 1,2018] ~ PETITION FOR CHANGE OF NAME