JUSTIN P. NICHOLS

ADAM B.J. POOLE

ATTORNEYS AT LAW

405 N. St. Mary’s St., Ste. 1000

San Antonio, Texas 78205

(210) 354-2300 phone

(800) 761-5782 facsimile

www.MakeItOfficialTexas.com

Rev. 12/3/2018

MAKE IT OFFICIAL

Serving the transgender community of Texas In the past, attorneys would charge a lot money (sometimes more than $3,000) to represent transgender clients through the process of obtaining a name and gender marker change. Unfortunately, many transgender people have delayed the transition or been unable to pay high attorney’s fees. The time has come to tear down the cost barrier. Name and gender marker changes should be available to everyone who needs it; not just to those who can afford it. Since 2015, we’ve offered our Make it Official program – a low cost service to the transgender community of Texas. The cost is $700, which includes all court filing fees, administrative fees, appearance at court, and four certified copies of the court order. You’ll also need a fingerprint card, which will cost $10, and you’ll spend about $50 to obtain a new driver’s license and birth certificate (a new Social Security card is free). If you’re unable to pay the filing fee, we have included an affidavit to have the fees waived, but you will still need to pay the administrative fee of $400. We will complete the necessary paperwork, file them with the court, prepare the order, and accompany you to the courthouse to appear before a judge and present the application. Afterwards, we can provide information and assistance in obtaining your new identification documents.

How to Participate

The process is simple. Attached is a checklist of everything you’ll need, with instructions, and a form to fill out. Once you put everything together, send it to us. We’ll file everything and call you to set up a court date (normally within a month). On the day of court, you’ll meet at our office and we will accompany you to the courthouse where one of our attorneys will appear before the judge with you. Afterwards, we’ll review everything you need to do to obtain new identification documents. If you are seeking a gender marker change for a minor, please call our office before submitting a packet. Of course, every situation is different, and there may be circumstances which require special attention, but we’ll help you through them as much as we can. If you submit you packet remotely, you should only have to come to downtown San Antonio one time for your court date. If you have questions, just call us at (210) 354-2300, or send us an email to: MakeItOfficial@TheNicholsLawFirm.com. You can complete the packet it and return it without making an appointment. If there are any problems or questions, we’ll contact you to get it sorted out. It’s our hope this will be a valuable and welcome service to the transgender community. You already are who you are, so let’s Make it Official!

Client’s Current Legal Name: ______________________________ Check here if you are ONLY

❑ seeking a gender marker change.

Client’s New Name: ________________________________ (the cost is the same)

Rev. 4/30/19

CHECKLIST

Questionnaire (fully completed, and every blank filled in) Affidavit in Support of Name and/or Gender Marker Correction

o This form must be notarized. Our officer offers free notary services if you need it.

Fingerprint card

o Go to your local police or sheriff’s office and tell them you need an FBI-compatible fingerprint card. You will need to bring proof of your identity. The fee is around $10, so you may call first and ask, and verify the method of payments accepted.

*** IMPORTANT *** Beginning January 1, 2019, you must show you have received a total of 12 months of treatment or therapy. You do not need 12 months of each, but the total, between the two, must be 12 months.

Letter from mental health professional certifying the name/gender marker

change is appropriate, and stating the length of time you have been in therapy.

o If you don’t have one, call Adam Sauceda, LPC-S at (210) 853-0503 or Joseph Montaldi, LCSW at (210) 201-4824 to schedule an evaluation.

Affidavit from medical professional certifying, in detail, you have undergone

permanent clinical and/or physiological steps to confirm your gender identity, and the length of time you have been receiving treatment.

$700 (for all court fees, administrative costs, and certified copies of the order)

Cash (personally deliver your packet, do not mail it) Cashier’s check or money order (payable to “The Nichols Law Firm”) Credit card (use the payment authorization form below) Affidavit of Inability to Pay Costs (you must receive governmental aid).

You will still need to pay administrative costs of $400.

If paying by credit card, please complete the information below: Name on Card: _______________________________ Card Number: ______________________________ Exp. Date: _______ Security Code: _____ Billing address: _______________________________________________________________ I authorize a payment of $700 (or $400 if completing an Affidavit of Inability to Pay).

_______________________________________ Signature of Cardholder

INSTRUCTIONS Once you have everything on this checklist, you may mail or deliver your packet to: The Nichols Law Firm, PLLC, 405 N. St. Mary’s St., Ste. 1000, San Antonio, Texas 78205. If you are paying by credit card, you may fax your packet to (800) 761-5782, or email it to: MakeItOfficial@TheNicholsLawFirm.com

Rev. 11/16/18

Name & Gender Marker Correction Questionnaire

Current Legal Name: _____________________________________________ New Name: _______________________________________________ What gender was assigned to you at birth? _____________ What is your current gender identity/expression? ______________ Date of Birth: ____________________ City and State of Birth: ___________________ Social Security No.: ______________________ Driver’s License No.: ______________ (If you don’t have one, write “none”)

What is your race/ethnicity? ________________ Residential Address: ______________________________ _______________________________ Silly question, but have you ever been required to register as a sex offender? ________ Have you ever been assigned an FBI or SID number? __________ (You get one of these if you’re arrested).

If yes, what is the number? _____________________________

Have you ever been convicted of an offense greater than a traffic ticket? ___________ If yes, please explain (dates, case numbers, where it occurred, and the disposition of the case). ______________________________________________________________________ Name of your mental health provider? ______________________________

How long have you been in mental health therapy? ________________

Name of your medical treatment provider? _________________________

How long have you been receiving medical treatment? _______________ Are you seeking this change to avoid a criminal investigation or to avoid debts? ______ Email: _______________________________ Phone: __________________________ Under penalty of perjury, I swear / affirm the answers above are true and correct. SIGN HERE: ____________________________________

❑ Check here if you are ONLY seeking a gender marker correction.

Rev. 5/3/17

AFFIDAVIT IN SUPPORT OF NAME and/or GENDER MARKER CORRECTION

*** Do not sign this form until you are personally before a notary ***

STATE OF TEXAS § § COUNTY OF _________________ § On this day, before me, the undersigned notary public, did personally appear

__________________________________, (current legal name) and after being duly sworn, deposed:

“My current legal name is ______________________________. I am over the age of 18, of sound mind, and in able condition to make this affidavit. I am filing a petition asking the Court to change my name and/or correct my gender marker. I swear and affirm the information in my petition is true and correct.” __________________________ SIGNATURE (sign your current legal name)

SWORN TO and SUBSCRIBED before me on: __________________. __________________________ Notary Public – State of Texas (seal)

Rev. 11/16/18

MEDICAL PROVIDER’S AFFIDAVIT CONCERNING GENDER MARKER CHANGE / CORRECTION

Patient’s Name: ______________________________ Date of Birth: _______________ Provider’s Name: _______________________________ License Type: ____________ (i.e. M.D., P.A., F.N.P., etc.)

Address: _________________________________________ Phone: _____________________ Date provider began treating patient: ________________________ Provider has supervised and treated patient in/for the following diagnoses, treatment(s), prescription(s), procedure(s), or other medical service(s) in support and furtherance of patient’s gender transition/confirmation (be specific – simply writing ‘hormone therapy’ is not sufficient): ____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

It is my professional opinion and diagnosis that the patient’s true and correct gender identity is

____________________. The patient has undergone permanent and irreversible clinical and/or

physiological steps to confirm the patient’s true gender identity.

Furthermore, it is my professional opinion and recommendation that any identification

documents or other records which show the patient’s gender as anything but the patient’s true

gender identity should, in all respects, be corrected to show the patient’s correct gender It is my

professional opinion that these changes and corrections are medically necessary to confirm the

patient’s true gender identity and expression.

_____________________________ Signature of Medical Provider

SWORN TO and SUBSCRIBED before me on __________________. ___________________________ Notary Public – State of Texas

Page 1 of 2 Rev. 10/11/16

NOTICE: THIS DOCUMENT CONTAINS SENSITIVE DATA.

Instructions: This form is prescribed by the Texas Supreme Court, Misc. Docket No.: 16-9122, and is

ONLY to be used if you absolutely cannot afford to pay court costs. This document may be contested by

the clerk or the Court. If any information you provide is untrue, there can be serious consequences.

DON’T SIGN IT UNTIL YOU ARE IN FRONT OF A NOTARY.

CAUSE NO.: __________________ (leave blank)

IN RE: § IN THE DISTRICT COURT

§

_____________________________________, § BEXAR COUNTY, TEXAS

(print current legal name) §

PETITIONER. § ____ JUDICIAL DISTRICT (leave blank)

STATEMENT OF INABILITY TO AFFORD PAYMENT OF COURT COSTS

1) My current legal name is: _________________________________, born on: _____________.

2) My address is: ______________________________________________________________.

3) My phone number is: _________________. My email is: _____________________________.

4) I have the following dependents (people who depend on me financially):

A. _______________________________________ Age:______ Relationship:___________

B. _______________________________________ Age:______ Relationship:___________

C. _______________________________________ Age:______ Relationship:___________

5) I am not represented by legal aid. I did not apply for representation by legal aid. My attorney

is not representing me on a contingent basis.

6) I receive the following public benefits: (check all that apply and write the amount you receive per month)

□ food stamps / SNAP ($______ per month)

□ TANF ($______ per month)

□ Medicaid ($______ per month)

□ CHIP ($______ per month)

□ SSI ($______ per month)

□ WIC ($______ per month)

□ Unemployment ($______ per month)

□ Section 8 Housing ($______) per month)

□ Low Income Energy ($______ per month)

□ Emergency Assistance ($____ per month)

□ Telephone Lifeline ($______ per month)

□ DADS Community Care ($____ per month)

□ LIS in Medicare ($______ per month)

□ Needs-based VA help ( ($_____ per month)

□ Child Care Assistance ($______ per month)

□ County/City Provided Help ($___ per month)

□ Other (describe and how much): _________________________________________________

□ I don’t receive any public benefits of governmental assistance.

Page 2 of 2 Rev. 10/11/16

7) I receive the following income per month (if none, write $0):

$_________ in wages. I work as a ___________________ at ___________________. (job title) (employer)

$_________ in total public benefits (add the amounts from #6 above).

$ _________ from other’s in my household (including your spouse, if any).

$ _________ from (check all that apply): □ Child Support □ Tips, bonuses □ Disability

□ Social Security □ Military Housing

□ Retirement/Pension □ Dividends/interest

$ __________ from other jobs/sources (describe: _______________________________)

$ __________ TOTAL MONTHLY INCOME (add all lines in #7).

8) I own the following property (check all that apply): 9) My monthly expenses are:

□ Home / real estate (value: $__________)

□ Vehicle(s) (value: $_____________)

□ Boat / RV (value: $_____________)

□ Jewelry (value: $_____________)

□ Stocks/bonds (value: $_____________)

□ Bank Accounts (total on deposit: $___)

□ Cash on hand (amount: $_________)

□ Other (value: $_________)

TOTAL PROPERTY: $_____________ (add the lines above)

□ Mortgage/Rent: $__________

□ Car Payment: $____________

□ Food: $___________

□ Gas / Bus Fare: $____________

□ Clothing / Laundry: $___________

□ Credit Card Payments: $________

□ Student Payments: $_________

□ Child care / school: $_________

□ Medical Bills/Expenses: $_________

□ Other: $_________

TOTAL MONTHLY BILLS: $____________ (add the lines above)

10) I would like the Court to consider the following circumstances about my situation:

_____________________________________________________________________________

_____________________________________________________________________________

11) I declare, under penalty of perjury, that the foregoing is true and correct. I further swear I

cannot afford to pay court costs.

_______________________________

SIGNATURE OF PETITIONER

SWORN TO and SUBSCRIBED before me on:

_______________. (date)

___________________________________

Notary Public – State of Texas (seal)