Mendocino — MNC-110

Source: https://www.mendocino.courts.ca.gov/forms_and_filing/forms/MNC-110.pdf

TO: SHERIFF’S OFFICE – ATTN: DISPATCH (e-mail: Communications@mendocinocounty.org)

Case Number:

DECLARATION re: CHANGE OF NAME (Code of Civil Procedure § 1279.5)

I have filed, in the Superior Court of Mendocino County, either a Petition for Change of Name or a Petition for Change of Name, Recognition of Change of Gender, and Issuance of New Birth Certificate of the following person: Name (current name): Last First Middle Date of Birth

mm dd yyyy

List any AKAs: Last First Middle

Other information: Sex Height Weight Hair Color Eye Color Driver’s License No. and State

I certify under penalty of perjury under of laws of the State of California that the foregoing is true and correct.

Date: Signature

INFORMATION REQUEST

Pursuant to CCP § 1279.5 the Court requests that the Sheriff of Mendocino County examine the records available through California Law Enforcement Telecommunications System (CLETS) and the Criminal Justice Information System (CJIS) to determine whether or not the above applicant is under the jurisdiction of the Department of Corrections or is required to register as a sex offender pursuant to Penal Code § 290 and to report the result of such examination to the Court via e-mail at NameChanges@mendocino.court.ca.gov.

Date Examination Requested: ___ _____________________________________ Deputy Clerk of the Court

RESPONSE from the SHERIFF’S OFFICE

A check of the records has been made as requested. We find: no information

the following information:

Date: Signature

MNC-110 (04/12/2021)