Fill and Sign the Consent to Change of Form

Consent to Change of Name of MinorPage 1 of 2 Your Name (first, middle, last) Street Address Town, State, Zip Code Telephone Number SUPERIOR COURT OF NEW JERSEY LAW DIVISION Atlantic County Docket Number (to be filled in by the court) In the Matter of the Application of Your Name (first, middle, last) To Assume the Name of Name you wish to assume (first, middle, last) CIVIL ACTION CONSENT TO CHANGE OF NAME OF MINOR 1. I, , am the mother or father of the minor child . 2. I understand that a petition for the change of my child’s name will be presented to the Superior Court of County. 3. I understand that I have a right to participate in the hearing and to voice objection to the change of name. 4. I give up any objection and consent to the change of name. 5. I give up my right to be present at any hearing on this change of name. 6. I request that the Court grant the name change. Consent to Change of Name of MinorPage 2 of 2 Signature of Parent Type or Print Name Address Telephone number State of New Jersey, County of I CERTIFY that on the day of , 20 personally came before me and acknowledged under oath to my satisfaction, that this person (or if more than one, each person): a) is named in and personally signed the attached document; b) signed and delivered this document as his/her/their act and deed; and Notary Public Type or Print Name