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Noin the Supreme Court of the United States in Form

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IN THE DISTRICT COURT OF __________________ COUNTYSTATE OF OKLAHOMA IN THE MATTER OF ) ) Case No. _________________ ) Minor Petitioner ) STATE OF OKLAHOMA ) )ss County of __________________ ) MINOR CONSENT TO NAME CHANGE[Age 12 and older] The undersigned, being first duly sworn upon oath, states: 1. I am the Minor Petitioner in the above entitled action. 2. I was born on the ______ day of __________________, ______, in the City/Town of __________________, in the State of __________________. I am presently ______ years of age. 3. My current full name is: (Full Current Name) I am aware of this action that would result in a change of my name to: (Full Proposed New Name) I hereby CONSENT to changing my names to the proposed new names shown above. ____________________________________ Signature Print/Type Full Name State of Oklahoma County of __________________ Before me, a ________________________, in and for said state, on this ______ day of __________________, 20______, personally appeared ______________________________ to me known to be the identical person who executed the within and foregoing instrument and acknowledged to me that he/she executed the same as his/her free and voluntary act and deed for the uses and purposes therein set forth. Subscribed and sworn to before me this ______ day of __________________, 20______. Notary Public My commission expires: Type or Print Name

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