Petition filed

Cal. Super. - 5th Dist.July 12, 2021

NC-500 ATTORNEY OR PARTY WITHOUT ATTORNEY TELEPHONE NO.: FAX NO.: E-MAIL ADDRESS: ATTORNEY FOR (name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME: CASE NUMBER:PETITION FOR RECOGNITION OF MINOR'S CHANGE OF GENDER Use this form only for a petition relating to a minor. (Petitioners 18 years or older must use form NC-200 or NC-300.) Before you complete this petition, read the Instructions for Filing (form NC-500-INFO). Everyone must complete items 1 through 5 and the affidavit on the back. If you are seeking a name change in addition to recognition of gender change, you must also complete items 6, 7, and 8, and form NC-110. If the petition is being brought by a guardian or a dependency attorney appointed as guardian ad litem, also complete form NC-510G. 1. This request is being made by (minor's present name): and (check one of the following) Petitioners request the court to order that a new birth certificate be issued reflecting the gender change sought by this petition.3. Petitioners request a decree recognizing that minor's gender is changed to: a. female. c. nonbinary. 4. a. 5. The minor has no living parent. 6. Petitioners request that the court decree that the minor's name is changed to conform to minor's gender identity to (proposed name): (If petitioner has already obtained a decree of change of name for the minor, attach a certified copy of the decree to this petition. If no name change is requested, skip items 6, 7, and 8, and go to Affidavit.) Page 1 of 2 Form Adopted for Mandatory Use Code of Civil Procedure, § 1275 et seq.; Judicial Council of California Health and Safety Code, §§ 103430, 103435 NC-500 [Rev. January 1, 2019] www.courts.ca.gov NAME: FIRM NAME: STREET ADDRESS: CITY: STATE: ZIP CODE: 2. STATE BAR NUMBER: AND ISSUANCE OF NEW BIRTH CERTIFICATE b. male. PETITION FOR RECOGNITION OF MINOR'S CHANGE OF GENDER AND ISSUANCE OF NEW BIRTH CERTIFICATE a. two parents (names): b. one parent (name): c. near relative (name and relationship): d. guardian or dependency attorney appointed as guardian ad litem (name): e. other (specify): and CHANGE OF NAME Living parents of petitioning minor who did not sign this petition are (specify names and addresses, or check a box below): The minor has no living parent other than the parent or parents who signed this petition. Petitioners request that the court issue an order directing any living parent who did not sign this petition to file written objections and appear to show cause why the petition for recognition of gender change should not be granted. b. (Check if parents are deceased or cannot be located.) Petitioners request that the court issue an order directing any living grandparent to file written objections and appear to show cause why the petition for recognition of gender change should not be granted. ! !!!!! !!! ! ! ! ! Katherine Wood 336401 California Rural Legal Assistance, Inc. 338 S. A Street Oxnard CA 93030 805-483-8083 KWood@crla.org Adrian James Robbins,Bridgette Ilene Robbins,Dami n Fresno 1130 O Street 1130 O Street Fresno, CA 93721 B. F. Sisk Courthouse PETITION OF (name of each petitioner): In re: Dami n James Robbins (a minor) by parents Adrian James Robbins and Bridgette Ilene Robbins X Damian James Robbins X Adrian James Robbins and Bridgette Ilene Robbins X X X Diana Jane Robbins Diana Jane Robbins E-FILED 7/12/2021 4:24 PM Superior Court of California County of Fresno By: C. York, Deputy 21CECG01989 NC-500 CASE NUMBER: 8. The minor named in item 1 is a resident of this county. (This must be checked if a name change is requested.) NC-500 [Rev. January 1, 2019] PETITION FOR RECOGNITION OF MINOR'S CHANGE OF Page 2 of 2 GENDER AND ISSUANCE OF NEW BIRTH CERTIFICATE I (minor's present name): female male nonbinarylaws of the state of California that the request for a change in gender to (check one): is to conform my legal gender to my gender identity and is not for any fraudulent purpose. declare under penalty of perjury under the Date: (TYPE OR PRINT NAME OF MINOR) (SIGNATURE OF MINOR) Date: (TYPE OR PRINT NAME OF PETITIONING PARENT/GUARDIAN) (SIGNATURE OF PETITIONING PARENT/GUARDIAN) Date: (TYPE OR PRINT NAME OF PETITIONING PARENT/GUARDIAN) (SIGNATURE OF PETITIONING PARENT/GUARDIAN) Date: (TYPE OR PRINT NAME OF PETITIONING PARENT/GUARDIAN) (SIGNATURE OF PETITIONING PARENT/GUARDIAN) Date: (TYPE OR PRINT NAME OF PETITIONING PARENT/GUARDIAN) (SIGNATURE OF PETITIONING PARENT/GUARDIAN) AND CHANGE OF NAME 7. Petitioners provide the following information in support of this petition: a. The affidavit on page 2 of this form. b-f. The information contained in the attachment. (If seeking a name change, you must attach a completed copy of the attachment Name and Information About the Person Whose Name Is to Be Changed (form NC-110).) ! ! ! ! ! PETITION OF (name of each petitioner): In re: Dami n James Robbins (a minor) by parents, Adrian James Robbins and Bridgette Ilene Robbins X X DECLARATION Dami n James Robbins X Dami n James Robbins Adrian James Robbins Bridgette Ilene Robbins Diana Jane Robbins 21CECG01989 NC-110 CASE NUMBER: FOR CHANGE OF NAME NAME AND INFORMATION ABOUT THE PERSON Attachment ofWHOSE NAME IS TO BE CHANGED 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. If petitioner is a guardian of a minor, a supplemental attachment, Declaration of Guardian (form NC-110G), 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. Self Other (1) Present name (specify): (2) Proposed name (specify): (3) Born on (date of birth): and presently under 18 years of age over 18 years of age (4) Born at (place of birth): (5) Sex (as stated on original birth certificate): Male Female (6) Current residence address (street, city, county, and zip code): c. Reason for name change (explain): d. Relationship of the petitioner to the person whose name will be changed: (1) self (4) near relative (indicate relationship): (2) parent (5) Other (specify): (3) guardian 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 if neither 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 I declare under penalty of perjury under the laws of the State of California that (check one) I am not I am under the jurisdiction of the California Department of Corrections and Rehabilitation (in state prison or on parole) or in county I am not I amjail and (check one) Date: (TYPE OR PRINT NAME OF PERSON WHOSE NAME IS TO BE CHANGED) (SIGNATURE OF PERSON WHOSE NAME IS TO BE CHANGED) (If petitioner is represented by an attorney, the attorney's signature follows): Date: (TYPE OR PRINT NAME) (SIGNATURE OF 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.) I 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: (TYPE OR PRINT NAME) (SIGNATURE OF PETITIONER) Date: (TYPE OR PRINT NAME) (SIGNATURE OF PETITIONER) ADD ADDITIONAL SIGNATURE LINES FOR ADDITIONAL PETITIONERS SIGNATURE OF PETITIONERS FOLLOWS LAST ATTACHMENT Form Adopted for Mandatory Use ATTACHMENT TO Code of Civil Procedure, § 1275 et seq. Judicial Council of California NC-110 [Rev. September 1, 2018] PETITION FOR CHANGE OF NAME required to register as a sex offender under Penal Code section 290. www.courts.ca.gov Page 1 of 1 ! ! ! ! ! ! ! !! !! ! ! ! ! ! ! PETITION OF (Name of petitioner or petitioners): In re: Dami n James Robbins (a minor) by parents, Adrian James Robbins and Bridgette Ilene Robbins 1 1 X Damian James Robbins Diana Jane Robbins 09/09/2011 X Selma, CA X 162 Meadow Lane, Kingsburg, CA 93631 To conform my name and gender to my identity. X Adrian James Robbins 162 Meadow Lane, Kingsburg, CA 93631 Bridgette Ilene Robbins 162 Meadow Lane, Kingsburg, CA 93631 Katherine Wood Adrian James Robbins Bridgette Ilene Robbins Diana Jane Robbins 21CECG01989