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Civil Court of the City of New YorkCounty of Index Number In the Matter of the Application of ORDER Upon the petition of verified the day of , 20 , seeking leave to change the name of the Minor Petitioner from to , and the court being satisfied thereby that the petition is true and that there is no reasonable objection to the change of name proposed,Now, on motion of it isORDERED, that the Minor Petitioner, born on , , at , County of whose birth certificate number is is hereby authorized to assume the name in place of his/her present name upon compliance with the provisions of this order, and it is further ORDERED, that this order shall be entered and the papers on which it was granted filed, prior to the publication hereinafter ordered, in the office of the Clerk of the County of wherein petitioner resides, and it is further ORDERED, that at least once within twenty days after entry of this order, a notice shall be published in the , substantially in the form prescribed by Section 63 of the New York Civil Rights Law. ORDERED, that within forty days of the making of this order, an affidavit of publication as of the aforesaid notice shall be filed in the office of the Clerk of the County of , and it is further ORDERED, that upon full compliance with the above provisions of this order, the Minor Petitioner shall be known by the name which he/she is hereby authorized to assume and by no other name. ENTER DATED: , New York , 20 ____________________________________ J. S. C.