Fill and Sign the After Having Considered Said Petition Finds as Fact as Follows Form

IN THE CIRCUIT COURT OF COUNTY WEST VIRGINIA IN THE MATTER OF THE PETITION OF Civil Action No. Judge FOR A CHANGE OF NAME TO ORDER FOR NAME CHANGE THIS matter came on for hearing on a Petition to Change Name filed by Petitioner and the court after having considered said Petition finds as fact as follows: 1. That this Court has jurisdiction of the parties and subject matter and venue is proper. 2. That the Petitioners are of full legal age and is a bona fide resident of the County of , State of West Virginia, whose residence address is . Petitioners have been a bona fide resident of County, State of West Virginia for years immediately prior to filing this Petition. 3. Petitioners’ and minors’ present names are as follows: Name: Birth date: Age: Address: Name: Birth date: Age: Address: Name: Birth date: Age: Address: Name: Birth date: Age: Address: 4. That the Petitioners pray for the change of name for the following reasons: (describe in detail): 5. That the proposed change in names will not be detrimental to the interests of any other person and is not against the public interest. 6. This Petition is not filed to defraud creditors or to obstruct criminal prosecution or for other fraudulent purposes. 7. Petitioners are (check one) not married or is married to . 8. Petitioners (check one) own no real estate or own real estate in County, . 9. Petitioners (check one) have not have been convicted of a crime. The nature, punishment, and information regarding said conviction are as follows: 10. Petitioners have met the publication requirements. IT IS THEREFORE ORDERED, ADJUDGED AND DECREED, that the name of the said PETITIONERS and their minor children are hereby changed as follows: From To Petitioners: Minor Children: DATED this day of , 20 . BY THE COURT: ____________________________________CIRCUIT COURT JUDGE Prepared and Presented by: