Fill and Sign the Name Change and Form

-1- STATE OF SOUTH CAROLINA )IN THE FAMILY COURT OF THE )____________ JUDICIAL CIRCUIT COUNTY OF _______________ ) ) EX PARTE: )ORDER AND CERTIFICATE OF) NAME CHANGE AND )AMENDMENT OF BIRTH )CERTIFICATE Plaintiff ) Docket No. ______________ I find that (1) this Court has jurisdiction over this matter pursuant to Section 20-7-420(8) & (9), Code of Laws of South Carolina, 1976, as amended; (2) the party is entitled and not in any way disqualified to have his/her name changed; (3) that the applicable provisions of Section 15- 49-10, Code of Laws of South Carolina, 1976, as amended, have been complied with; and, (4) that the following reasons exist for the change of name: I further find that the following information appears on the birth certificate of the party whose name is to be changed: Full Name at BirthFull Name of Father Date of BirthFull Maiden Name of Mother Birthplace: County and State Full Name at BirthFull Name of Father Date of BirthFull Maiden Name of Mother Birthplace: County and State Full Name at BirthFull Name of Father -2- Date of BirthFull Maiden Name of Mother Birthplace: County and State Full Name at BirthFull Name of Father Date of BirthFull Maiden Name of Mother Birthplace: County and State IT IS, THEREFORE, ORDERED that the name of the party be changed and may be so reflected in the birth certificate of the party. From To Date: PRESIDING JUDGE ______ JUDICIAL CIRCUITPlaintiff’s Address