Fill and Sign the Affidavit Name Change Form 497428392

IN THE CIRCUIT COURT OF ______________ COUNTY, VIRGINIA IN RE: CHANGE OF NAME FOR MINOR CHILD No. ________________ FROM: _________________________ TO: ____________________________ AFFIDAVIT FOR SERVICE BY PUBLICATION Comes now _____________________________ Petitioner herein, seeking service on ____________________ the natural parent by ORDER OF PUBLICATION, and who under oath deposes and states under oath that the Natural Parent in this cause, Is a non-resident individual, other than a non-resident individual fiduciary who has appointed a statutory agent; OR Cannot be found, and that diligence has been used without effect to ascertain the location of the party to be served; OR Cannot be served with court process, and that a return has been filed by the Sheriff which shows that the process has been in his or her hands for twenty-one (21) days and the Sheriff has been unable to make service; OR OTHER: _________________________________________________________________________ and the last known mailing address of Natural Father/Mother is as follows: Name: ____________________________________________ Address: ____________________________________________ ____________________________________________ OTHER INFORMATION: ___________________________________________________________ Explanation of circumstances: ___________________________________________________________ __________________________________________ Signature of Petitioner _________________________________________ Counsel for Petitioner TO BE COMPLETED BY A NOTARY PUBLIC/OR DEPUTY CLERK In the Commonwealth/State of ________________________ In the County of : ______________________ Subscribed and sworn to before me by ____________ this _____ day of ____________, ______. _________________________________ My Commission Expires: __________________ Notary Public/Deputy Clerk