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Fill and Sign the Ny Name Change 497321750 Form

Fill and Sign the Ny Name Change 497321750 Form

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SUPREME COURT OF THE STATE OF NEW YORK COUNTY OF       NOTICE BY PUBLICATION IN THE MATTER OF THE APPLICATION OF:       A Minor FOR LEAVE TO CHANGE HIS/HER NAME TO: INDEX NUMBER             Notice is hereby given that an order entered by the Supreme Court of       County on       , 20       , Index #       /97, 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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