San Benito — SB-CV-2

Source: https://www.sanbenito.courts.ca.gov/system/files/sbcv2.pdf

SB-CV-2 NAME CHANGE BACKGROUND INFORMATION FORM

Pursuant to CCP 1279.5, the court is required to conduct a background investigation to determine whether an applicant for name change is required to register as a sex offender pursuant to PC 290. To conduct this investigation, the following form must be completed. In the process of completing this form, please print your information. If any section does not apply to you, please indicate “NA”.

-THIS FORM MUST BE KEPT CONFIDENTIAL-

LAST NAME: FIRST NAME: MIDDLE NAME:

LIST ANY OTHER NAMES THAT YOU USE, INCLUDING MAIDEN NAME, BIRTH NAME OR NICKNAME:

RESIDENCE STREET ADDRESS: CITY/STATE: ZIP: PHONE NUMBER

MAILING ADDRESS IF DIFFERENT FROM RESIDENCE: BUSINESS PHONE

DATE OF BIRTH: AGE: PLACE OF BIRTH: SEX: HEIGHT: WEIGHT: HAIR: EYES: (STATE OR COUNTRY)

DRIVERS LIC NO: STATE: EXPIRATION DATE: SOCIAL SECURITY NO: U.S. CITIZEN;

YES NO

SCARS, MARKS OR TATTOOS: IF YES, DESCRIBE

I certify the above information is correct.

Signature: _____________________________________________________________ Date: ___________________________

FOR COURT USE ONLY: DATE SENT TO COMMUNICATIONS: _________ CASE NUMBER: _____________________________ DATE DUE BACK TO COURT: ________________ DATE OF APPLICATION: _____________________ HEARING DATE:_____________________________

Form Adopted for Mandatory Use NAME CHANGE Superior Court of California, County of San Benito SB-CV-2 [eff. 1/1/20] BACKGROUND INFORMATION FORM page 1 of 1