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Fill and Sign the Notice is Hereby Given that an Order Entered by the Supreme Court of Form

Fill and Sign the Notice is Hereby Given that an Order Entered by the Supreme Court of Form

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Civil Court of the City of New YorkCounty of Index Number In the Matter of the Application of NOTICE BY PUBLICATION Notice is hereby given that an order entered by the Supreme Court of County on , 20 , Index # /____, copy of which may be examined at the office of the County Clerk, located in County, , grants the Minor Petitioner the right affected on , 20 to assume the name of . The Minor Petitioner’s present name is . The Minor Petitioner’s address is . The Minor Petitioner’s place of birth is on , . ____________________________________ Petitioner Print/Type Name ____________________________________ Petitioner Print/Type Name

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