• My current full name is Current_First_Name Current_Middle_Name Current_Last_Name.

• I wish to change my name to New_First_Name New_Middle_Name New_Last_Name.

• My date of birth is Birthdate.

• I am 18 years of age or older.

• I am a resident of Jefferson County.

• I have not been convicted of a felony or adjudicated a juvenile delinquent for an offense that would constitute a felony if committed by an adult in this state or any other state or under federal law. My certified, fingerprint-based criminal history record check from the FBI is attached as Exhibit A and my certified, fingerprint-based criminal history record check from the CBI is attached as Exhibit B. Both are dated within 90 days of the filing of this Petition pursuant to §13-15-101(b), C.R.S.

• The proposed change of name would be proper and not detrimental to the interest of any other person.

• checkbox1 ​​ I ask the Court to order publication of my name change request as required by C.R.S. 13-15-101, OR

 checkbox2 ​​ Publication of my name change request is not required per C.R.S. 13-15-102(4).

_________________________________________________________________________________________

I ask the court to order the name change. I, Current_First_Name Current_Middle_Name Current_Last_Name, swear/affirm under oath that I have read the foregoing Petition and that the statements contained in this Petition are true to the best of my knowledge.

Date: ______________    __________________________________________________        Signature of Petitioner

My Commission Expires: __________________  _____________________________________________      Deputy Clerk/Notary Public

The Court having read and considered the Petition for Change of Name finds:

• That the statements made in the Petition satisfy the statutory requirements.

• That the desired change of name is proper and not detrimental to the interests of any other person.

• That the Petitioner has submitted the documentation required in §13-15-101(1)(b), C.R.S. from the fingerprint-based criminal history record check or has provided appropriate certified copies of any dispositions that would constitute a felony conviction in this state or any other state or under federal law.

The Court orders the following publication for a change of name:

​​ 

• Name of Current_First_Name Current_Middle_Name Current_Last_Name is requested to be changed to New_First_Name New_Middle_Name New_Last_Name.

• Pursuant to statute, public notice of this change of name shall be published once in a legal newspaper published in this county. This publication is to be made within 21 days of the date of this Order.

• Proper proof of publication shall be filed with the Court upon final publication to receive a Final Decree for a Change of Name.

Date: ___________________________    _____________________________________

         ​​ Judge   ​​ Magistrate

Public Notice is given on      ​​ (date) that a Petition for a Change of Name of an Adult has been filed with the Jefferson County Court.

The Petition requests that the name of Current_First_Name Current_Middle_Name Current_Last_Name

be changed to New_First_Name New_Middle_Name New_Last_Name.

___________________________________________

Clerk of Court

By ________________________________________

Deputy Clerk

NEWSPAPER: ​​ PLEASE PUBLISH THIS NOTICE ONCE WITHIN TWENTY-ONE DAYS OF THE DATE OF THE ORDER.

The Court having read and considered the Petition for Change of Name, finds:

• The statements made in the Petition satisfy the statutory requirements.

• The desired change of name is proper and not detrimental to the interests of any other person.

• If the Petitioner is over 14 years of age, the Petitioner has submitted the documentation required in §13-15-101(1)(b), C.R.S. from the fingerprint-based criminal history record check or has provided appropriate certified copies of any dispositions that would constitute a felony conviction in this state or any other state or under federal law. The Court finds the Petitioner has no felony convictions and has not previously been convicted of a felony or adjudicated a juvenile delinquent for an offense that would constitute a felony if committed by an adult.

• If the Petitioner is under 19 years of age, the change of name is in the best interest of the minor child.

• Petitioner has provided proper proof of publication or publication is not required.

The Court Orders the following change of name:

​​ 

The name of Current_First_Name Current_Middle_Name Current_Last_Name born on Birthdate (date of birth) is changed to New_First_Name New_Middle_Name New_Last_Name.

Date: ___________________________    _____________________________________

Judge  Magistrate

Combined Court

County of Jefferson, State of Colorado

Certified to be a full, true and correct copy of the original in my custody.

Clerk of the Combined Court

By________________________  _____________________

Deputy Clerk    Date