Verbeck Law

2081 Center St,

Berkeley, CA, 94704

(415) 212-8253

Affordable and Effective Legal Help

info@verbecklaw.com | California | (415) 212-8253

Verbeck Law

Worksheet for Name Changes

This page collects information that allows Verbeck Law to complete the forms required for a court-ordered name change. Not all the fields will necessarily apply to your case, but please try to give as much information as possible here. Ask us if you have any questions, of course.

Name

First Name

Last Name

Date of Birth

YYYY

Current home address

Give your present residential address in the county you live in.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone Number - Cell

(###)

###

####

Phone number - Business

This is required in counties that conduct background checks as a matter of course, like Santa Clara.

(###)

###

####

Place of birth

Please give city and country.

Sex

Female

Male

Other

Height, weight, eye color, hair color

This is also required in counties that do background checks.

Driver's license and state

If more convenient, you can send us a scan of your license, and we can pull data for this question and the one above.

Driver's License expiration date

YYYY

Social Security Number and Citizenship

This information is kept confidential by both Verbeck Law and the courts, but counties that conduct background checks do require a CLETS filing with SS and immigration status.

Notable scars or tattoos?

This can help agencies differentiate between common names.

Any other names you've gone by?

Include past legal names, maiden names, etc.

Do you certify that you're not under the jurisdiction of parole, probation, or any similar agency?

Yes

Do you certify that you are not currently required by any court to register as a sex offender?

Yes