Fill and Sign the Consent Change Name 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 Parent, Guardian or Custodian) (DOM REL 63) 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 as Parent or Guardian. I am the mother the father (or) the guardian of       (current name of child)       , born on       ,       . (date of birth) 3. Consent. I hereby consent that the minor child’s name be changed from       (current name of child)       to       . 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 the date 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 the name of a child will not change an existing child support obligation. Page 1 of 1 DR 63 – Revised 13 Feb 2001