Fill and Sign the Application for Change of Name of Family Form

1 _____________________ COUNTY PROBATE COURT _________________ , JUDGE IN RE: CHANGE OF NAME OF: to Present Name Name Requested to Present Name Name Requested , a minor to Present Name Name Requested , a minor to Present Name Name Requested , a minor to Present Name Name Requested , a minor to Present Name Name Requested CASE NO. APPLICATION FOR CHANGE OF NAME OF FAMILY [R.C. 2717.01] A. The applicant, ____________________________________ states that the applicant is an adult and has been a bona fide resident of ______ County, Ohio, for at least one year immediately prior to the filing of this application.Applicant further states that Applicant was born on the ______ day of __________________, ______, in the City of __________________ , County of __________________, in the State of ________________________ . The applicant requests a change of name from to for himself herself and for the minor(s) listed below for the following reason: .The applicant, ____________________________________ further states that the applicant is the Father Mother legal guardian guardian ad litem of the minor(s) listed in Section C. below and that the minor(s) has/have been a bona fide resident of County, Ohio, for at least one year immediately prior to the filing of this application. A certified copy of the birth certificate of each minor is attached. The applicant further states that the applicant will cause notice of this application to be published once in a newspaper of general circulation in this county at least thirty (30) days before the hearing on this application. B. 2 The applicant, ____________________________________ states that the applicant is an adult and has been a bona fide resident of County, Ohio, for at least one year immediately prior to the filing of this application.Applicant further states that Applicant was born on the ______ day of __________________, ______, in the City of __________________ , County of __________________, in the State of ________________________ . The applicant requests a change of name from to for himself herself and for the minor(s) listed below for the following reason for the following reason: .The applicant, ____________________________________ further states that the applicant is the Father Mother of the minor(s) listed in Section C. below and joins in the request of applicant ____________________________________ for the minor(s) name changes as listed in Section C. C. As to each minor child, Applicant states:Name ________________________ D.O.B.____________Place of Birth: __________________ The name and address of the mother of the minor is: Name Address City State Zip The name and address of the father or alleged father of the minor is: Name Address City State Zip Applicant states that the address of the mother father or alleged father is unknown and cannot with reasonable diligence be ascertained. There is no person alleged to be the father of said minor. The applicant requests the minors name be changed from to for the reason stated above. Name ________________________ D.O.B.____________Place of Birth: __________________ The name and address of the mother of the minor is: 3 Name Address City State Zip The name and address of the father or alleged father of the minor is: Name Address City State Zip Applicant states that the address of the mother father or alleged father is unknown and cannot with reasonable diligence be ascertained. There is no person alleged to be the father of said minor. Name ________________________ D.O.B.____________Place of Birth: __________________ The name and address of the mother of the minor is: Name Address City State Zip The name and address of the father or alleged father of the minor is: Name Address City State Zip Applicant states that the address of the mother father or alleged father is unknown and cannot with reasonable diligence be ascertained. There is no person alleged to be the father of said minor. ___________________________________________ _________________________________________Attorney for Applicant Applicant’s Signature Typed or Printed Name Typed or Printed Name Address Address 4 City State ZipCity State Zip Telephone Number (include area code) Telephone Number (include area code)Attorney Registration No. _____________________ ____________________________________________Applicant’s SignatureTyped or Printed NameAddress _____ City State ZipTelephone Number (include area code) 5 JOURNAL ENTRY SETTING HEARING AND ORDERING NOTICE The Court orders this application set for hearing on the day of , , at o’clock a/p.m. The applicant is ordered to cause notice of the application to be given by one publication in a newspaper of general circulation in this county at least thirty (30) days prior to the hearing date as required by law. _____________________________________________________ Probate Judge By: ____________________________________________________ Deputy Clerk