Confidential — Retained Clients Only

Name Change Questionnaire

Adult Name Change · Minor Name Change · NewLeaf Document Services

LDA #23-003 · Placer County · Registered & Bonded

Please complete before your appointment.
This questionnaire collects the information needed to prepare your name change petition. Please answer every question carefully and accurately — the information here will appear directly on your court documents.

This questionnaire is confidential and for retained clients only.

Type of Name Change

Who is requesting the name change? *

An adult — myself A minor child

County of residence *

Current mailing address *

Adult Name Change — Your Information

Current legal first name *

Current legal middle name

Current legal last name *

Proposed new first name *

Proposed new middle name

Proposed new last name *

Date of birth *

Place of birth *

Reason for name change (court may ask at hearing)

Have you ever been convicted of a felony? *

Yes No

💡 Felony convictions must be disclosed on the petition. The court will still typically grant the name change but may ask questions at the hearing. JoHanna will discuss this with you.

Are you required to register as a sex offender? *

Yes No

⚠️ Additional requirements apply for registered sex offenders seeking a name change. JoHanna will discuss these requirements with you at your appointment.

Have you previously filed for a name change in any court?

Yes No

💡 Please provide the court, case number, and outcome of the prior name change if you have it.

Do you have any safety concerns about your name and address being published in a newspaper?

Yes No

💡 If you have safety concerns about publication — such as domestic violence, stalking, or address confidentiality needs — you may qualify for the Safe at Home program or a court waiver of publication. JoHanna will discuss your options at your appointment. Safe at Home: (877) 322-5227.

Minor Name Change — Child & Parent Information

Child's Information

Current legal first name *

Current legal middle name

Current legal last name *

Proposed new first name *

Proposed new middle name

Proposed new last name *

Child's date of birth *

Child's place of birth *

Petitioning Parent Information

Your full legal name *

Your relationship to child

Other Parent Information

Other parent's full legal name *

Other parent's current address (for service)

Does the other parent agree to the name change?

Yes — agrees No — objects or unknown Cannot be located Parental rights terminated

⚠️ If the other parent objects — the matter may become contested and the client may need an attorney. If the other parent cannot be located — service by publication may be required. JoHanna will discuss next steps at your appointment.

Is there an existing custody order?

Yes No

💡 Please upload a copy of the existing custody order using the upload field below.

Reason for name change

Upload & Submit

Upload any relevant documents (optional)

💡 Upload existing custody orders, prior name change filings, or any other relevant documents.

Questions or anything to discuss (optional)

💡 After filing, publication in a local newspaper is required for most name changes. JoHanna will coordinate this on your behalf. The newspaper fee (typically $50–$200) is paid directly to the newspaper — not to NewLeaf.

Something went wrong. Please try again or contact JoHanna at (916) 751-6498.

🌿 Thank You — Questionnaire Received!

JoHanna will review your information before your appointment.

(916) 751-6498 — Call or text
newleafoffice.us@gmail.com

NewLeaf Document Services · LDA #23-003 · Not a Law Firm · Not an Attorney

NewLeaf Document Services · JoHanna C. Cody, LDA #23-003 · Placer County · Registered & Bonded
(916) 751-6498 · newleafoffice.us@gmail.com · NewleafDocumentServices.com
This questionnaire is confidential. Not a Law Firm. Not an Attorney.

Name Change Questionnaire

Child's Information

Petitioning Parent Information

Other Parent Information

🌿 Thank You — Questionnaire Received!

Explore

Get In Touch