Confidential Cover Sheet—Name Change Proceeding Under Address Confidentiality Program (Safe at Home) (Change of Name)
California · Judicial Council of California · Effective July 1, 2026
This form is a cover sheet used when filing papers to start a name change case if the person is part of the Safe At Home program and wants the court to keep the case private. It is used to attach to the main petition and other related documents.
The court describes it as: Use this as a cover sheet when you file papers to start a name change case if you are in the Safe At Home program and are asking the court to keep your case confidential.
Where this fits in a case
Start a caseStage: Start a case
This form is used by a person who is an active participant in the Safe At Home program and is asking the court to change their name to avoid issues like domestic violence, stalking, sexual assault, or human trafficking.
Usually filed by the person starting the case.
Official instructions
How-to guides published by the court for this form.
Common questions
- Who should file this form?
- The instructions state that the petitioner should use this form when filing papers to start the name change case.
- When should I file this form?
- The petitioner should not file the Petition for Change of Name (form NC-100) until they receive a letter confirming they are an active participant in Safe At Home and that the name change is on file with Safe At Home.
- What does this form keep confidential?
- Under Code of Civil Procedure section 1277(b), the current legal name of the petitioner must be kept confidential by the court.
Revision history
No changes recorded since we started tracking this form on October 9, 2026. The current version took effect July 1, 2026.
Related forms
- CM-010
Civil Case Cover Sheet
This form is a Civil Case Cover Sheet that asks for basic details about a civil case being started. It requires checking the type of case, noting if the case is complex, and listing what the parties are asking the court for.
MandatoryFillable PDFStart a case
Eff. Jul 1, 2026
- NC-100
Petition for Change of Name
This form is used to start a case asking the court to officially change a name or the name of a minor child. It asks for the current legal name and the new name that is being requested.
MandatoryFillable PDF3 translationsStart a case
Eff. Jul 1, 2026
- NC-110
Name and Information About the Person Whose Name is to be Changed (Attachment to Petition for Change of Name)
This form is an attachment used when someone files a request to change a name. It asks for details about the person whose name is changing, including their current and desired new name, and the reason for the change.
MandatoryFillable PDF3 translationsStart a case
Eff. Jul 1, 2026
- NC-120
Order to Show Cause—Change of Name
This form is used to ask the court for an official order to change a person's name. It tells everyone involved that a name change is being requested and sets the date, time, and place for a hearing.
MandatoryFillable PDFJudgment
Eff. Jan 1, 2023
- NC-130
Decree Changing Name
This form is a court order that officially states the judge's decision about changing a person's name or a minor child's name. It records the old name and the new name that the court has approved.
MandatoryFillable PDF3 translationsJudgment
Eff. Jul 1, 2026
- NC-410
Application to File Documents Under Seal in Name Change Proceeding Under Address Confidentiality Program (Safe at Home)
This form is used to ask a judge to keep certain papers from a name change case private by filing them under seal. It requires the person filing to also submit a Declaration in Support of the Application.
MandatoryFillable PDFStart a case
Eff. Jan 1, 2010
- NC-420
Declaration in Support of Application to File Documents Under Seal in Name Change Proceeding Under Address Confidentiality Program (Safe at Home)
This form is a written statement used to ask the court to keep documents related to a name change private (under seal). It requires the person filing it to explain why keeping the records secret is necessary to protect them from danger.
MandatoryFillable PDFStart a case
Eff. Jan 1, 2019
- NC-425
Order on Application to File Documents Under Seal in Name Change Proceeding Under Address Confidentiality Program (Safe at Home)
This form is an order from the judge that tells you if the court will keep certain papers from your name change case private. It states whether the request to keep documents secret was approved or denied.
OptionalFillable PDFStart a case
Eff. Jan 1, 2010