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IN THE CHANCERY COURT OF ___________________ COUNTY, MISSISSIPPI IN THE MATTER OF THE PETITION OF FOR CHANGE OF NAME CAUSE NO. __________________ ORDER ON PETITION TO CHANGE NAME THIS DAY this cause came on for hearing on Petition of the Petitioner, __________________ and __________________, to change name of the Petitioner(s) and minor child(ren) and after having considered said Petition and finding that the Court has jurisdic tion of the parties and subject matter, finds as follows: 1. That this Court has jurisdiction over the parties and subject matter. 2. That the Petitioner is/are an adult bona fide resident citizen of _______________________, County, Mississippi and is/are the Parents Guardians of ______________________________ and ______________________________, minors, whose current residence and mailing address is __________________, __________________, Mississippi __________________. Petitioner has been such for more than six (6) months year next preceding the date of filing of this Petition; this Court has proper jurisdiction of the Petitioner and of the subject matter. 3. Petitioner(s) request(s) a change of name for the Petitioner(s) and minor child(ren) as follows: From To Petitioners: Minor Children: 4. That the Petitioner prays for the change of name for the following reasons: (describe in detail ____________________________________________________________. 5. The Petitioner(s) and minor child(ren) were born on the following dates: Name: Age: DOB: Name: Age: DOB: Name: Age: DOB: Name: Age: DOB: Name: Age: DOB: 6. Petitioner would show that the minor is not the convict of a felony and that this Petitioner has not filed to change the name of the minor for any unlawful purpose nor to com mit fraud on any person. The minor has never filed bankruptcy and there are no claims, demands, liabilities or obligations of any kind whatsoever against the minor that would be adversel y affected by this Petition. No Creditors of the minor would be adversely affected by granti ng this Petition. 7. Petitioner would show that it is appropriate and in accordance with the Mississippi Code Section 93-17-1 (1972) and is in the best interest of the minor that this Pet ition be granted. IT IS, THEREFORE, ORDER AND ADJUDGED that the Petition For Name Change is well taken and that minor's name is hereby changed as follows: From To Petitioners: Minor Children: ____________________________________ CHANCERY JUDGE PREPARED AND PRESENTED BY: