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`Cie S10
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`ATTORNEY OR PARTY WITHOUT ATT(
`-(Name, State Bar number, and address):
`
`
`FOR COURT USE ONLY
`Justine Papa Phalichanh
`
`In Pro Per
`350 Glenview Drive, Apartment 7 San Francisco CA 94131
`TELEPHONENo.: (615) 556-9126
`FAX NO.(Optional):
`
`E-MAIL ADDRESS: JUStinpDapa@me.com
`
`ATTORNEYFOR (Name): Justine Papa Phalichanh
`cf
`i
`Lact
`é
`
`
`Franai antySuperior Courtzh
`
`
`SUPERIOR COURT OF CALIFORNIA, COUNTY.OF San Francisco
`San Francisco County
`p
`street appress: 400 McAllister Street
`MAILINGADDRESS:
`|
`.
`FEB 18 2022
`CITy AND zip cope: San Francisco 94102
`
`BRANCH Name: Civic Center Courthouse
`CASE NAME:
`
`
`
`
`
`
`CIVIL CASE COVER SHEET
`Complex Case Designation
`CASE NUMBER:
`[__"] Limited
`[-__] Counter
`[___] Joinder
`CNC - or ~5 5 6 95 ?
`[¥] Unlimited
`=
`
`
`
`(Amount
`(Amount
`—
`demanded
`demandedis
`Filed with first appearance by defendant
`exceeds $25,000)
`$25,000orless)
`(Cal. Rules of Court, rule 3.402) °
`
`
`
`ltems 1-6 below must be completed (see instructions on page 2).
`1. Check one box below for the case type that best describes this case:
`
`Auto Tort
`Contract
`[__] Auto (22)
`Breachof contract/warranty (06)
`[__] Uninsured motorist (46)
`Rule 3.740collections (09)
`Other PI/PDAWD(Personal Injury/Property
`[—] Othercollections (09)
`Damage/WrongfulDeath)Tort
`[___]
`Insurance coverage (18)
`
`[___] Asbestos (04)
`[—] Othercontract (37)
`Productliability (24)
`Real Property
`[___] Medical malpractice (45)
`Eminent domain/Inverse
`|
`Other PI/PD/WD(23)
`~~ condemnation (14)
`Non-Pl/PD/WD(Other) Tort
`Wrongfuleviction (33)
`
`Business tort/unfair business practice (07)
`Other real property (26)
`
`Civil rights (08)
`Unlawful Detainer
`[___] Defamation (13)
`|__| Commercial (31)
`|__| Fraud (16)
`Residential (32)
`
`Intellectual.property (19)
`[__] Drugs (38)
`|___] Professionalnegligence(25)
`Judicial Review .
`Other non-P/PD/WDtort (35)
`[__] Assetforfeiture (05)
`Employment
`[-_] Petitionre: arbitration award (11)
`
`Writ of mandate (02)
`Wrongfultermination (36)
`Otherjudicial review (39)
`Other employment (15)
`complex underrule 3.400 ofthe California Rules of Court. If the case is complex, mark the
`2. Thiscase [| is
`[¥] isnot
`
`factors requiring exceptional judicial management:
`[___}.Large numberof witnesses
`d.
`a. [__] Large numberof separately represented parties
`e. [7] Coordination with related actions pending in one or more
`b. [__] Extensive motion practiceraising difficult or novel
`courts in other counties, states, or countries, or in a federal
`issues that will be time-consuming to resolve
`court
`[__]} Substantial amount of documentary evidence
`[_] Substantial postjudgmentjudicial supervision
`f.
`.
`3. Remedies sought (checkall that apply):a. [__] monetary b. [4] nonmonetary; declaratory orinjunctive relief c.
`4. Numberof causesofaction (specify): 1
`
`5. This case []is
`[#]isnot
` aclass action suit.
`6.
`If there are any knownrelatedcases,file and serve a notice of related case, AKOU ma
`
`Date:
`ge
`
`
`Justin Papa Phalichanh
`Ww
`
`
`(TYPE OR PRINT NAME)
`
`
`(SIGNATURE OF PARTY OR ATTORNEYFOR PARTY)
`
`
`:~NOTICE - ;
`7)
`* Plaintiff mustfile this cover sheet with the first paper filed in the action or proceeding (except small claims casesor casesfiled
`under the Probate Code, Family Code, or Welfare and Institutions Code). (Cal. Rulesof Court, rule 3.220.) Failure tofile may result
`in sanctions.
`* File this cover sheetin addition to any cover sheetrequired by local court tule.
`*
`If this case is complex underrule 3.400 et seq. of the California Rules of Court, you must serve a copyof this cover sheetonall
`other parties to the action or proceeding.
`¢ Unlessthis is a collections case underrule 3.740 ora complex case, this cover sheetwill be used for statistical purposes only.Page 1 of 2
`
`ae ean
`CIVIL CASE COVER SHEET Mn,Souuinamamasmare
`Judicial Council of California
`
`Provisionally Complex Civil Litigation
`(Cal. Rules of Court, rules 3.400—3.403)
`["_]} AntitrustTrade regulation (03)
`[__] Construction defect (10)
`[__] Masstort (40)
`[~_] Securitieslitigation (28)
`Environmental/Toxic tort (30)
`[| Insurancecoverageclaimsarising from the
`epee(di) provisionally complex case
`Enforcement of Judgment
`[__] Enforcementof judgment(20)
`Miscellaneous Civil Complaint
`[] Rico (27)
`[___] Other complaint (not specified above) (42)
`MiscellaneousCivil Petition
`{__] Partnership and corporate governance (21)
`Lv] Petitionfor ameChange (43)
`
`‘
`
`
`
`c.
`
`[___] punitive
`
`

`

`COVER SHEET
`RUCTIONS ON HOWTO COMPLETE1
`|
`To Plaintiffs and Others Fiung First Papers.
`If you arefiling a first paper (fo: caample, a complaint) in a civil case, you must
`complete andfile, along with yourfirst paper, the Civil Case Cover Sheet contained on page 1. This information will be used to compile
`statistics about the typés and numbersof casesfiled. You must complete items 1 through 6 on the sheet.
`in item 1, you must check
`one box for the case type that best describes the case.
`If the casefits both a general and a morespecific type of caselisted in item 1,
`check the more specific one.If the case has multiple causesofaction, check the box that best indicates the primary causeofaction.
`To assist you in completing the sheet, examples of the cases that belong under each casetypein item 1 are provided below. A cover
`sheet mustbefiled only with your initial paper. Failure to file a cover sheet with thefirst paperfiled in a civil case may subject a party,
`its counsel, or both to sanctions underrules 2.30 and 3.220 of the California Rules of Court.
`To Parties in Rule 3.740 Collections Cases.A "collections case" under rule 3.740 is defined as an action for recovery of money owed
`in a sum stated to be certain that is not more than $25,000, exclusive of interest and attorney's fees, arising from a transaction in which
`property, services, or money was acquired on credit. A collections case does not include an action seeking the following: (1) tort
`damages,(2) punitive damages,(3) recovery of real property, (4) recovery of personal property, or (5) a prejudgmentwrit of
`attachment. The identification of a case as a rule 3.740 collections case on this form meansthatit will be exempt from the general
`time-for-service requirements and case managementrules, unless a defendantfiles a responsive pleading. A rule 3.740 collections
`’ case will be subject to the requirements for service and obtaining a judgmentin rule 3.740.
`To Parties in Complex Cases. In complex cases only, parties must also use the Civil Case Cover Sheet to designate whether the
`case is complex.If a plaintiff believes the case is complex underrule 3.400 of the California Rules of Court, this must be indicated by
`completing the appropriate boxes in items 1 and 2.If a plaintiff designates a case as complex, the cover sheet must be served with the
`complaint onall parties to the action. A defendant mayfile and serve no later than the timeofits first appearance a joinderin the
`plaintiffs designation, a counter-designation that the case is not complex, or,if the plaintiff has made no designation, a designation that
`CASE TYPESAND EXAMPLES
`the case is complex.
`Contract
`Auto Tort
`Breach of Contract/Warranty (06)
`Auto (22)—PersonalInjury/Property
`Breach of Rental/Lease
`;
`Damage/Wrongful Death
`Contract (not unlawful detainer
`Uninsured Motorist (46) (if the
`or wrongful eviction)
`case involves an uninsured
`Contract/Warranty Breach—Seller
`motorist claim subject to
`Plaintiff (not fraud or negligence)
`arbitration, check this item
`Negligent Breach of Contract!
`instead of Auto).
`Warranty
`:
`Other Pi/PD/WD(Personal Injury/
`Other Breach of Contract/Warranty
`Property Damage/Wrongful Death)
`Collections (e.g., money owed, open
`Tort
`book accounts) (09)
`Asbestos (04)
`Collection Case~Seller Plaintiff
`Asbestos Property Damage
`Other Promissory Note/Collections
`Asbestos PersonalInjury/
`Case
`:
`Wrongful Death
`Insurance Coverage (not provisionally
`Product Liability (not asbestos or
`complex) (18) .
`foxic/environmental) (24)
`Auto Subrogation
`Medical Malpractice (45)
`Other Coverage —
`-Medical Malpractice—
`Other Contract (37)
`Physicians & Surgeons
`Contractual Fraud
`OtherProfessional Health Care
`Other Contract Dispute
`Malpractice
`Real Property
`Other PI/PD/WD(23)
`Eminent Domain/Inverse
`PremisesLiability (e.g., slip
`Condemnation (14)
`andfall)
`Wrongful Eviction (33)
`Intentional Bodily Injury/PD/WD
`Other Real Property (e.g., quiettitle) (26)
`(e.g., assault, vandalism)
`Writ of Possession of Real Property
`Intentional |nfliction of
`Emotional Distress
`Mortgage Foreclosure
`Quiet Title
`NegligentInfliction of
`Other Real Property (not eminent
`' Emotional Distress
`domain, landiord/tenant, or
`Other PI/PD/WD
`foreciosure)
`Uniawful Detainer
`Commercial (31)
`Residential (32)
`Drugs (38) (if the case involvesillegal
`drugs, checkthis item; otherwise,
`report as Commercial or Residential)_
`Judicial Review
`:
`
`.
`
`Non-Pl/PD/WD (Other) Tort
`-Business Tort/Unfair Business ~
`Practice (07)
`Civil Rights (e.g., discrimination,
`false arrest) (not civil
`harassment) (08)
`Defamation (e.g., slander, libel)
`(13)
`Fraud (16)
`Intellectual Property (19)
`Professional Negligence (25)
`Legal Malpractice
`Other Professional Malpractice
`(not medical or legal)
`Other Non-Pl/PD/WDTort (35)
`Employment
`Wrongful Termination (36)
`Other Employment(15)
`:
`po,
`an
`CM-010 [Rev. September 1, 2021]
`
`AssetForfeiture (05)
`Petition Re: Arbitration Award (11)
`Writ of Mandate (02)
`Writ-Administrative Mandamus
`
`Writ-Mandamuson Limited Court
`Case Matter
`©
`* Writ-Other Limited Court Case
`Review’
`Other Judicial Review (39)
`Review of Health Officer Order -
`
`Notice of Appeal—-Labor
`CommissionerAp} eals
`CIVIL CASE COVER SHEET
`
`:
`
`CM-010
`
`.
`
`Provisionally Complex Civil Litigation (Cal.
`Rules of Court Rules 3.400-3.403)
`Antitrust/Trade Regulation (03)
`Construction Defect (10)
`Claims Involving MassTort (40)
`Securities Litigation (28)
`Environmental/Toxic Tort (30)
`Insurance Coverage Claims
`(arising from provisionally complex
`case type listed above) (41)
`Enforcement of Judgment
`‘Enforcement of Judgment(20)
`Abstract of Judgment (Out of
`County)
`Confession of Judgment (non-
`domestic relations)
`_ Sister State Judgment
`Administrative Agency Award
`(not unpaid taxes)
`Petition/Certification of Entry of
`Judgment on Unpaid Taxes
`Other Enforcement of Judgment
`Case
`MiscellaneousCivil Complaint
`RICO (27)
`Other Complaint (not specified
`above) (42)
`Declaratory Relief Only
`Injunctive Relief Only (non-
`harassment)
`Mechanics Lien
`Other Commercial Complaint
`Case (non-tort/non-complex)
`OtherCivil Complaint
`(non-tort/non-complex)
`MiscelianeousCivil Petition
`‘ Partnership and Corporate
`Governance(21)
`OtherPetition (not specified
`above) (43)
`Civil Harassment
`Workplace Violence
`Elder/DependentAdult
`Abuse
`Election Contest
`Petition for Name Change
`Petition for Relief From Late
`Claim |
`OtherCivil Petition
`
`.
`
`Page 2 of 2
`
`

`

`NC-100
`ATTORNEY OR PARTY WITHOUT ATTORNEY
`.
`STATE BAR NUMBER:
`
`\
`
`name: Justine Papa Phalichanh
`FIRM NAME:
`
`STREET ADDRESS:350 Glenview Drive, Apartment 7
`city:San Francisco
`
`sTaTE:CA
`
`ZIP CODE: 94131
`
`.
`
`E-MAILADDRESS:justinpapa@me.com
`TELEPHONE NO.: (615) 556-9126
`ATTORNEYFOR(name): Justin Papa Phalichanh
`SUPERIOR COURT OF CALIFORNIA, COUNTY OF San Francisco
`sTREET ADDRESS: 400 McAllister Street
`MAILING ADDRESS:
`
`FAX NO.:
`
`.
`
`BRANCH NAME: Civic Center Courthouse
`PETITION OF (nameof eachpetitioner):
`Justine Papa Phalichanh
`
`- i BLA ie D
`q
`San Francisco County Superior Court
`
`FEB 1 8 2022
`
`BY:
`
`Deputy Clerk
`
`
`
`SowOF")—E COURT
`ciTyanozipcope:San Francisco 94102
`
` CASE NUMBER:
`PETITION FOR CHANGEOF NAME: enc -22-556957
`
`county where the person whose nameis to be changedresides.
`
`Before you complete this petition, you should read the Instructions for Filing a Petition for Change of Name (form NC-100-INFO). You
`must answerall questions and checkall boxes that apply to you on this petition. You mustfile this petition in the superior court of the
`
`1. Petitioner (present name): Justine Papa Phalichanh
`
`resides in this county.
`
`2. Petitioner requests that the court decree the following name changes(list every namethat you are seeking to change):
`
`PresentnameProposed name
`a. Justine Papa Phalichanh
`changedto Justin Papa Phalichanh
`
`b.
`
`c.
`
`d.
`
`changedto
`
`'
`
`changed to
`
`changed to
`
`[_] Continued (ifyou are seeking to change additional names, you must prepare a list and attach it to this petition as
`Attachment2.)
`;
`
`3. Petitioner requests that the court issue an order directing all interested persons to appearorfile objections to show cause why
`this petition for change of name of the persons identified in item 2 should not be granted.
`4. The numberof persons under 18 years of age whose namesare to be changedis (specify):0
`
`5.
`
`If this petition requests the change of name of any person or persons under 18 years, this request is being made by
`a.
`[__] two parents.
`- [-_] oneparent.
`- [_] nearrelative (nameandrelationship):
`[___] guardian (name):
`,
`
`[___] other (specify):
`6. [__] This petition seeks to change nameof (check one) [__]| petitioner|[[_] (name):
`
`to conform to that person's genderidentity.
`
`eoao5
`
`' 7. For each person whose nameis to be changed, petitioner provides the following information (you must attach a completed copy of
`the attachment Name andInformation About the Person Whose NameIs to Be Changed (form NC-110) for each person identified in
`item 2):
`a. The numberofattachmentsincludedin this petition is (specify number): 1
`b-f. (These are the items on the attached page or pages of Form NC-110.)
`pace
`1 of
`
`‘age 1
`o}
`Form Adopted for Mandatory Use
`a
`:
`'
`,
`Codeof Civil Procedure, 4278 et seq.
`Judicial Council of California .
`PETITION FOR CHANGE OF NAME
`.
`weicbutecnaey
`NC-100 [Rev. September 1, 2018)’
`(Change of Name)
`
`:
`
`,
`
`:
`
`

`

` NC-110
`PETITION OF (Nameofpetitioner or petitioners):
`CASE NUMBER:
`Justine Papa Phalichanh
`CNC
`27556937
`
`FOR CHANGE OF NAME
`.
`
`NAME AND INFORMATION ABOUT THE PERSON
`;
`WHOSE NAME IS TO BE CHANGED
`Attachmentto Petition (form NC-100, form NC-200, or form NC-500)
`(You must use a separate attachment for each person whose nameis to be changed.If petitioner is a guardian of a minor, a
`supplemental attachment, Declaration of Guardian (form NC-110G), must also be completed and attached for each minor whose name
`is to be changed.)
`7.
`(Continued) Petitioner applies for a decree to change the nameofthe following person:
`
`Attachment
`
`of
`
`[__] Other
`b. wl Self
`) Proposed name(specify):Justin Papa Phalichanh
`
`Present name(specify): Justine Papa Phalichanh
`
`-
`[W] over 18 years of age
`
`(3) Born on (date of birth): December 22, 1985
`and presently [7] under 18 yearsofage
`(4) Born at (place ofbirth): Clovis, New Mexico
`[__] Female
`(5) Sex (as stated on original birth certificate):
`[V4] Male
`(6) Current residence address(street, city, county, and zip code): 350 Glenview Drive, Apartment 7
`.
`San Francisco, CA, 94131, San Francisco County
`c. Reason for name change (explain):
`There wasa typo onthebirth certificate. The petitioner has beentrying to use the proposedforall his legal
`documents.
`
`d. Relationship of the petitioner to the person whose namewill be changed:
`
`(1) [4] self
`(4) [-_] nearrelative (indicate rélationship):
`(2)
`[__] parent
`(5) [_] Other(specify):
`(3) [| guardian
`If the person whose namewill be changediis under 18 years of age, provide the names and addresses, if known, ofthe
`following persons:
`(address):
`(1) Parent (name):
`(address):
`(2) Parent (name):
`(3)
`(Only if neither parentis living) Nearrelatives (names, relationships, and addresses):
`
`e.
`
`If the person whose namewill be changed is 18 years of age or older, that person must sign the following declaration:
`f.
`
`
`DECLARATION
`
`
`kone) [VY]
`lamnot
`[_] lam
`| declare under penalty of perjury underthe laws of the State of California that (che
`underthe jurisdiction of the California Department of Corrections and Rehabilita
`state prison or on parole) or in county
`
`ender under Penal Code section 290.
`jail and (check one)
`[W7]
`l|amnot [| !am'
`requiredto register as a 2
`
`
`
`Date:
`» DLh
` Justine Papa Phalichanh
`
`
`
`
`
`(TYPE OR PRINT NAME OF PERSONWHOSE NAME IS TO BE CHANGED)
`NATURE OF PERSON WHOSENAMEIS TO BE CHANGED)
`
`
`
`
`(if petitioner is represented by an attorney, the attorney's signature follows):
`Date:
`
`
`
`>
`
`(SIGNATURE OF ATTORNEY)
`,
`(TYPE OR PRINT NAME)
`(Each petitioner mustsign this petition in the space provided belowor,if additional pagesare attached,at the endof the last
`attachment.) | declare under penalty of perjury under the laws of the State of Californja
`that the information in the foregoing petition is
`true and correct.
`:
`Date:
`
`:
`
`Justine Papa Phalichanh
`
`(TYPE OR PRINT NAME)|
`
`Date:
`
`:
`
`.
`
`~
`
`a,
`
`,
`
`>
`oo
`
`
`(SIGNATUREOF PETITIONER)
`
`~~
`(SIGNATUREOF PETITIONER)
`,
`(TYPE OR PRINT NAME)
`Page 1of1
`SIGNATURE OF PETITIONERS FOLLOWS LAST ATTACHMENT
`ADD ADDITIONAL SIGNATURELINES FOR ADDITIONAL PETITIONERS
`,
`,
`CodeofCivil Procedure, § 4275 et seq.
`Form Adopted for Mandatory Use
`.
`.
`ATTACHMENT To
`Www.courts.ca.gov
`- Judicial Council of California
`.
`NC-110 [Rev. September 1, 2018]
`PETITION FOR CHANGE OF NAME
`
`;
`
`