Fill and Sign the Change Name Person Form

IN THE MATTER OF: * IN THE       * CIRCUIT COURT (child’s current name) * FOR FOR CHANGE OF NAME TO: *             (child’s new name) * BY AND THROUGH HIS/HER * Civil No.:       MOTHER/FATHER/GUARDIAN:       * (petitioner’s name) * * * * * * * * * * * * * CONSENT TO CHANGE OF NAME (Consent of Person Originally Listed on Birth Certificate) (DOM REL 64) 1. Name, Age and Competence. My name is       . My date of birth is       and I am capable of understanding what this consent means. 2. Status. I believe that I am NOT the father of       , (current name of child) born on       ,       , although I am listed as the father on his/her (date of birth) Certificate of Live Birth. 3. Consent. I hereby consent to having the child’s name changed. I hereby join in the foregoing Petition and waive notice of process. I acknowledge that I have the right to revoke my consent at any time prior to when an order changing the child’s name is entered. I acknowledge that I was provided the opportunity to consult with legal counsel, if I so chose, before signing this Consent. I SOLEMNLY AFFIRM under the penalties of perjury that the contents of the foregoing Consent are true to the best of my knowledge, information, and belief.       (Date) (your Signature       (your name - Printed)       (street address)       (city, state, zip)       (telephone number) NOTE: Changing a child’s name will not change an existing child support obligation. Page 1 of 1 DR 64 – Revised 13 Feb 2001