Mendocino — MNC-110

Source: https://www.mendocino.courts.ca.gov/system/files/forms-and-filings/mnc-110.pdf

TO: SHERIFF’S OFFICE – ATTN: DISPATCH (email: communications-all@mendocinosheriff.org)

Case Number:

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

I have filed, in the Superior Court of Mendocino County, a Petition for Change of Name of the following person: Name (current name): Last First Middle Date of Birth

List any AKAs:

First Middle Last

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

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.courts.ca.gov.

Date Examination Requested: Deputy Clerk of the Court

RESPONSE from SHERIFF’S OFFICE

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

the following information:

Date: Signature

MNC-110 (rev 0325)