Petition Name Gender ChangeCal. Super. - 6th Dist.April 29, 2021t_fv‘ ArrORNEY 0R PARTY WITHOUT ATrORNEY snug BAR NUMBER; DNA NAME: Holland McCormick Parish FIRM NAME; DNA STREET ADDRESS: 2004 Jardin Drive CITY: Mountain View STATE:CA ZIP CODEIQ404O TELEPHONE N0.: 650-505-9940 FAX N0.: E-MAIL ADDRESS: |anderoarish37®amaiLcom ATTORNEY FOR (name): [pro se] SUPERIOR COURT OF CALIFORNIA, COUNTY OF Santa Clara STREETADDRESS=191 N. First Street MAILING ADDRESS: 1 91 N. First Street CITY AND ZIP conE:San Jose. CA 951 13 BRANCH NAME: Probate Division PETITION OF (name): Holland McCormick Parish PETITION FOR CHANGE 0F NAME, RECOGNITION 0F CHANGE 0F CASENUMBEQZE, C V 3 8 U 9 0 b GENDER, AND ISSUANCE 0F NEW BIRTH CERTIFICATE - ‘ Before you cpmfilete this petition, {cu should read thg Instructions for Filin on the neggt page. You mu§t answer all questions and c eck all boxes tha apply to you on this petition. You must I e thls petition In the superior court of the county where the person whose name is to be changed resides. 1. Petitioner (presentname): Holland McCormick Parish is 18 years old or older and a resident of this county. 2. Petitioner requests that the court decree that petitioner’s name is changed, in order to conform to petitioner's gender identity, to (proposed name): Lander Elnur Parish 3. Petitioner requests a decree recognizing that the petitioner's gender is changed to: a. E female. b. E male. c. E nonbinary. 4. Petitioner requests that the court order that a new birth certificate be issued reflecting the gender and name changes sought by this petition. 5. Petitioner requests that the court issue an order directing any interested persons ‘0 file written objections to show cause why the petition for change of name should not be granted. 6. Petitioner provides the following information in support of this petition: a. The declaration below. b-f. The information contained in the attachment (attach a completed copy of the attachment Name and Information About the Person Whose Name ls to Be Changed (form NC-110)). DECLARATION I(present name):Holland McCormick Parish declare under penalty of perjury under the laws of the state of California that the request for a change in gender to (check one)E female E male E nonbinary is to conform my legal gender to my gender identity and is not for any fraudulent purpose. Date: April 20, 2021 Holland McCormick Pan'sh } 7 (TYPE OR PRINT NAME OF PETITIONER) (SIGNATURE 0F PETITIONER) (Instructions on next page) Pags1 o1 z Szazizzdszzziszxzzfismh PETITION FOR CHANGE 0F NAME: RECOGNITION 0F CHANGE Hea.$°:::;::::;::::?;:a331225.$33232 NC-200[Rev.5eptember1.201a] OF GENDER, AND ISSUANCE OF NEW BIRTH CERTIFICATE www.counuagov NC-110 PETITION OF (Name ofpetitioner orpetitioners): CASE NUMBER: Holland McCormick Parish FOR CHANGE OF NAME NAME AND INFORMATION ABOUT THE PERSON WHOSE NAME IS TO BE CHANGED Attachment of Attachment to Petition (form NC-1 00, form NC-ZOO, or form NC-500) (You must use a separate attachment for each person whose name is to be changed. lfpetitioneris a guardian of a minor, a supplemental attachment, Declaration of Guardian (form NC-1 106), must also be completed and attached for each minor whose name is (o be changed.) 7. (Continued) Petitioner applies for a decree to change the name of the following person: b. E Self E Other (1) Present name (specify): Holland McCormick Parish (2) Proposed name (specify): Lander Elnur Parish (3) Born on (date of birth): Mav 11. 2001 and presently E under 18 years of age E over 18 years of age (4) Born at (place ofbirth): Clovis. California (5) Sex (as stated on on‘ginal birth certificate): E Male E Female (6) Current residence address (street, city, county, and zip code): 2004 Jardin Drive, Mountain View, CA 94040 c. Reason for name change (explain): Petitioner is transgender and seeks the name change to conform to his gender idenity. 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 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): DNA (address): (2) Parent (name): (address): (3) (Onlyif 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 | declare under penalty of perjury under the laws of the State of California that (check one) E | am not E | 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 l am required to register as a sex offender under Penal Code section 290. Date: WVQ/Houmna McLo/Miok Palisk } 7 (TYPE OR PRINT NAME OF PERSON WHOSE NAME IS T0 BE CHANGED) (SIGNATURE OF PERSON WHOSE NAME IS TO BE CHANGED) (”petitioner is represented by an attorney, the attorney's signature follows): Date: DNA ’ (TYPE oR PRINT NAME) (SIGNATURE 0F Anomev) (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? April20. 2021 ' ' Holland McCormick Parish ’ (TYPE OR PRINT NAME) (SIGNATURE OF PETITIONER) Date: D (TYPE 0R PRINT NAME) (SIGNATURE OF PETITIONER)E ADD ADDITIONAL SIGNATURE LINES FOR ADDITIONAL PETITIONERS E SIGNATURE OF PETITIONERS FOLLOWS LAST ATTACHMENT page 1 o” Forfn-Adopled Ifor Mangalo'ry Use ATTACHMENT To Code of Civil Procedure, § 1275 at seq. fut“??é[°§e”v".°£§p'§fl§§rmfzom PETITION FOR CHANGE 0F NAME WWW‘W‘W For your protection and privacy, please press the Clear _ _ __ H This Form button after you have printed the form. I Printth-ls fon-nr I l Save this form LC‘EaI‘ thi's form
