
INSTRUCTIONS: This petition for change of name is being brought by a petitioner who is a participant in the Secretary
of State's address confidentiality program under Government Code section 6205 et seq. and who is petitioning (1) to
avoid domestic violence, (2) to avoid stalking, (3) to avoid sexual assault, or (4) to avoid human trafficking. As
provided by Code of Civil Procedure section 1277(b), the current legal name of the petitioner must be kept
confidential by the court and must not be published or posted in the court's calendars, indexes, or register of
actions, or by any means or in any public forum.
This Confidential Cover Sheet must be affixed to the first page of the petition and to any other documents filed
in this name change action. (
See Information Sheet for Name Change Proceedings Under Address Confidentiality Program)
(Safe at Home) (form NC-400-INFO).)
This cover sheet is affixed to the following documents (check all that apply):
Page 1 of 1
Form Adopted for Mandatory Use
Judicial Council of California
NC-400 [Rev. January 1, 2019]
CONFIDENTIAL COVER SHEET—NAME CHANGE PROCEEDING
UNDER ADDRESS CONFIDENTIALITY PROGRAM (SAFE AT HOME)
(Change of Name)
Code of Civil Procedure §§ 1277,
1278; Cal. Rules of Court, rule 2.575
www.courts.ca.gov
NC-400
2.
3.
7.
9.
6.
The name of the petitioner is to remain confidential UNLESS:
The petitioner's participation in the address confidentiality program is ended (Gov. Code, § 6206.7); or1.
The court finds by clear and convincing evidence that the allegations of domestic violence or stalking in the petition
are false. (Code Civ. Proc., § 1278(b).)
2.
1.
5.
4.
8.
CONFIDENTIAL
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
BRANCH NAME:
CITY AND ZIP CODE:
STREET ADDRESS:
MAILING ADDRESS:
PETITION OF (name of each petitioner):
[CONFIDENTIAL]
FOR COURT USE ONLY
CASE NUMBER:
CONFIDENTIAL COVER SHEET NAME CHANGE PROCEEDING UNDER
ADDRESS CONFIDENTIALITY PROGRAM (SAFE AT HOME)
STATE: ZIP CODE:CITY:
STREET ADDRESS:
FIRM NAME:
NAME:
TELEPHONE NO.: FAX NO.:
E-MAIL ADDRESS:
ATTORNEY FOR (name):
STATE BAR NUMBER:
ATTORNEY (leave blank if no attorney)
[CONFIDENTIAL]
Petition for Change of Name (form NC-100)
Attachment to Petition for the Name Change (form NC-110)
Order to Show Cause for Change of Name (form NC-120)
Decree Changing Name (form NC-130)
Civil Case Cover Sheet (form CM-010)
Application to File Documents Under Seal in Name Change Proceeding Under Address Confidentiality Program (Safe at
Home) (form NC-410)
Declaration in Support of Application to File Documents Under Seal in Name Change Proceedings Under Confidentiality
Program (Safe at Home) (form NC-420)
Order on Application to File Documents Under Seal in Name Change Proceeding Under Address Confidentiality Program
(Safe at Home) (form NC-425)
Other (describe):
Date:
For your protection and privacy, please press the Clear
This Form button after you have printed the form.