SUPERIOR COURT OF CALIFORNIA COUNTY OF ____________________ In the Matter of the | NO. ____________________ Application of | YOUR BIRTH NAME, | PETITION FOR CHANGE OF Petitioner, | NAME AND NEW BIRTH For Change of Name and | CERTIFICATE New Birth Certificate | _______________________________| Petitioner, (BIRTH NAME), [also known as _____,] alleges: 1. Petitioner is over 18 years of age. 2. Petitioner resides at (street address and city), (County), California. 3. Petitioner was born at (place of birth), California, on (date). The birth was recorded in state records showing petitioner's present name as (birth name) and petitioner's sex as (male or female). A copy of petitioner's birth certificate is attached hereto as Exhibit A and made a part hereof. 4. Petitioner's proposed name is (Proposed Name). 5. The reason for the proposed name change and the new birth certificate is that petitioner has undergone surgery for the purpose of alter petitiner's sexual characteristics to those of a (male or female). A physician's affidavit (or declaration - as appropriate) documenting the sex change is attached hereto as Exhibit B and made a part hereof. [EITHER] 6. Petitioner's parent is (Name), who resides at (street address, city, and state). [OR] 6. Petitioner's parents are both deceased. The names and places of residence of near relatives of petitioner, as far as known to petitioner, are as follows: Name Relationship Residence _________________ __________________ ____________ _________________ __________________ _____________ WHEREFORE, petitioner prays as follows: 1. For an order to show cause at a specified time and place why this petition should not be granted; 2. That, on the hearing, the court make an order changing petitioner's name from (birth name) to (proposed name). 3. That, on the hearing, this court make an order for issuance of a new birth certificate reflecting the change of petitioner's sex and name for filing in state records in lieu of the original record of petitioner's birth; and 4. That all other proper orders be granted. Dated:____________________ ____(Signature)_________ Petitioner