Fill and Sign the Full Text of Ampquotthe North Carolina Presbyterianampquot Form

Order and Certificate of Name ChangePage 1 of 2 STATE OF NORTH CAROLINA IN THE GENERAL COURT OF JUSTICE SUPERIOR COURT DIVISION COUNTY OF Before the Clerk of Superior Court IN RE: CHANGE OF NAME ) ) FROM: )ORDER AND CERTIFICATE OF (Minor’s current name) )NAME CHANGE TO: ) (Name Minor’s name should be changed to)) THIS CAUSE coming on to be heard before the undersigned Clerk of Superior Court upon Petitioner’s application on behalf of Minor Child to change his/her (Minor’s Current Name) legal name to , and upon the evidence presented, the Clerk finds the (Minor’s Proposed New Name) following: 1. That Minor Child is a resident of County, North Carolina and that Petitioner on behalf of said minor child has given ten (10) days notice of this application by publication at the Civil Courthouse bulletin board in said county, as by law provided. 2. That Minor Child was born on the , in (Date of Birth) (County of Birth) County, State of . His/her name listed on his/her birth certificate is (State of Birth) . His/her parents’ names as listed on his/her birth certificate are (Minor’s Name) and . (Mother’s Name) (Father’s Name) 3. That the name of , Minor Child, (has /has not) been changed by (Minor’s Name) law. If name has previously been changed, the circumstances are explained below: . 4. That consent of the Minor Child’s father (was /was not) given. If consent was not given, the circumstances are explained below: . Based upon the foregoing findings of fact, it is concluded as a matter of law that Minor Child is entitled to have his/her name changed to . (Minor’s Proposed New Name) Order and Certificate of Name ChangePage 2 of 2 THEREFORE, it is ordered that Minor Child’s legal name be changed to . (Minor’s Proposed New Name) This the ______ day of _______________, 20_______. ____________________________________CLERK OF SUPERIOR COURT FOR ____________ COUNTY, NORTH CAROLINA Plaintiff: Address: Phone: