Petition Name ChangeCal. Super. - 6th Dist.December 3, 2020NC-1 00 ATTORNEY OR PARTY WITHOUT ATTORNEY STATE BAR NUMBER; NAME: Roberta Elaine Komack \fillalobos FIRM NAME: STREEFADDRESS: 2571 Sturla Drive CITY: San Jose STATE: CA ZIP CODE: 95148 TELEPHONE No.2 408-274-8683 FAX No.: E-MAIL ADDRESS: beckv.villalobos@orodiav.net I ATTORNEY FOR(name): SeIf-Reoresented OCT 2 3 2020 I SUPERIOR COURT 0F CALIFORNIA, COUNTY 0F Santa Clara i I I STREET ADDRESS: 191 North First Street _Cl of the Court MAILING ADDRESS:191 North First Street SUW'W f G 6W 0' Santa Clara I c'ITY AND ZIP conasen Jose. CA 951 13 BY V DEPUTY BRANCH NAME:Civi| Division PETITION OF (name ofeach petitioner): Roberta Elaine Komack Villalobos CASE NUMBER: PETITION FOR CHANGE 0F NAME 2 0 C v3 77> 8 0 8 Before you complete this petition, you should read the Instructions for Filing a Petition for Change ofName (form NC-1 OO-INFO). You must answer all questions and check all boxes that apply to you on this petition. You must file this petition in the superior court of the county where the person whose name is to be changedvresides. 1. Petitioner (present name): Roberta Elaine Komack Villalobos resides in this county. 2. Petitioner requests that the court decree the following name changes (list every name that you are seeking to change): Present name Proposed name a. Roberta Elaine Komack changed to Becky Komack Villalobos b. "AKA Roberta E Komack" changed to c. "AKA Becky Komack" changed’to d. "AKA Becky K Villalobos? changed to E Continued (ifyou are seeking to change additional names, you must prepare a 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 file objections to show cause why this petition for change of name of the persons identified in item 2 should not be granted. 4. The number of persons under 18 years of age whose names are to be changed is (specify): rZERO 5. If this petition requests the change of name of any person or persons under 18 years, this request is being made by a. E two parents. . Eilone parent. - E near relative (name and relationship):E guardian (name): - E other (specify): 6. E This petition seeks to change name of (check one) E petitioner E: (name): to conform to that person's gender identity. OU' m9 7. For each person whose name is to be changed, petitioner provides the following information (you must attach a completed copy of the attachment Name and Information About the Person Whose Name ls to Be Changed (form NC-1 1 0) for each person identified in item 2): a. The number of attachments included in this petition is (specifi/ number): 1 b-f. (These are the items on the attached page orpages ofform NC-1 10.) Page 1 of 1 Form Adopted for Mandatory Use Code of Civil Procedure, § 1275 et seq. Judicial Com, ofCammia PETITION FOR CHANGE OF NAME m_wmmgov Nc-1on [Rev. September 1. 201s] (Change of Name) For your protection and privacy, please press the Clear This Form button after you have printed the form. W3 II Savelthisff'orm 1| 'V flhb‘fl-fo‘nnlii NC-110 PETITION OF (Name ofpetitioner orpetitioners): Roberta Elaine Komack Villalobos CASE NUMBER: FOR CHANGE OF NAME NAME AND INFORMATION ABOUT THE PERSON WHOSE NAME Is To BE CHANGED Attachment 1 of 1 Attachment to Petition (form NC-100, form NC-200, or form NC-500) (You must use a separate attachment for each person whose name‘is to be changed. pretitioner is a guardian of a min'or, a supplemental attachment, Declaration of Guardian (form NC-1 1OG), must also be completed and attached for each minor whose name is to be changed.) 7. (Continued) Petitioner applies for a decree to change the name of the following person: b. E Self D Other (1) Present name (specify): Roberta Elaine Komack Villalobos. "AKA Robeta E. Komack"AKA Beckv Komack“. » (2) Proposed name (specify): Beckv Komack Villalobos (3) Born on (date of birth): 09/1 3/1 946 and presently E under 18 years of age E over 18 years of age (4) Born at (place of birth): Broome Countv. Johnson Citv New York (5) Sex (as stated on original birth certificate): E Male E Female (6) Current residence address (street, city, county, and zip code): 2571 Sturla Drive! San Jose, Santa Clara County, CA 95148 c' Reason for name Change (eXP’W-hll my Legal Documents are Becky Komack (married name) Villalobos NOT Roberta Elaine Komack | didn't think I needed to legally change. My CA drivers lisence now Becky Komack Villalobos doesn't match Birth Ceni d. Relationship of the petitioner to the person whose name will be changed: (1) x self - (4) E near relative (indicate relationship): (2) parent (5) E Other (specify): (3) E guardian I e. If the person whose name will be changed'Is under 18 years of age, provide the names and addresses, if known. of the following persons. (1) Parent (name): (address): (2) Parent (name): - (address):‘ (3) (Only ifneither parent is living) Near relatives (names, relationships, and addresses): f. If the person whose name will be changed is 18 years of age or older, that person must sign the following declaration; DECLARATION | declare under penalty of perjury under the laws of the State of Califqmia that (check one)E I am not E l am under the jurisdiction of the California Department of Corrections and Rehabilitation (in state prison or on parole) or in county jail and (check one) E | am not E I am required to register as a sex offender under Penal Code section 290. Date: 10/08/2020 “Lawbeau Roerta Elaine Komack Villalobos - }WMWWWL (TYPE 0R PRINT NAME 0F PERSON WHOSE NAME IS TO BE CHANGED) (SIGNATURE 0F PERSON WHOSE NAME IS T0 BE CHANGED) (lfpetitioner'Is represented by an attorney, the attorney's signature follows): Date. D (TYPE OR PRINT NAME) (SIGNATURE 0F ATTORNEY) (Each petitioner must sign this petition in the space provided below or,,if additional pages are attached, at the end of the last attachment.) l declare under penalty of perjury under the laws of the State of California that the information in the foregoing petition is true and correct. ,Date: 10/08/2020 ‘ MW Robera Elaine Komack Villalobos ’W}WWW (TYPE OR PRINT NAME) (SIGNATURE 0F PETITIONER) Date: I } (TYPE OR PRINT NAME) (SIGNATURE 0F PEHTIONER) [_| ADD ADDITIONAL SIGNATURE LINES FOR ADDITIONAL PETITIONERS [’_| SIGNATURE 0F PETITIONERS FOLLows LAST ATrACHMENT page 1 o“ Fon'n'Adopled .for Man.dato'ry Use ATTACHMENT To Code of Civil Procedure, § 1 275 é! seq. fl??é?£§£°§§&§f£§2§"fi‘zmm PETITION FOR CHANGE 0F NAME W““”S'°a'g°v For your protection and privacy, please press the Clear This Form button after you have printed the form. “ Elia I Sayejhisfiifiyil [m
