Fill and Sign the Pa Name Change Minor Form

IN THE COURT OF COMMON PLEAS OF __________________ COUNTY, PENNSYLVANIA CIVIL ACTION - LAW IN RE: CHANGE OF NAME OF : NO. __________________ :       : a minor : :       : a minor : : CONSENT TO NAME CHANGE I hereby declare the following: 1. My name is ______________________________ and I currently reside at ____________________________________ in the city of __________________ , in the county of ________________________ in the state of __________________ , and have so resided for a period of _____ years and       months prior to the making of this application. 2. I am the natural father of ______________________________ minor child born on the _____ day of __________________ , ______ . I am also the natural father of ______________________________ minor child born on the _____ day of __________________ , ______ . 3. I consent to the Petition to Change Name of ________________________ , a Minor Child, from ________________________ to ________________________ . I also consent to the Petition to Change Name of ________________________ , a Minor Child, from ________________________ to ________________________ . 4. I understand the legal effect of such a change of name, and I have no objections to this court issuing an order to effect said change of name. /// /// /// /// /// /// /// Consent to Name Change Page 1 of 2 I hereby certify that all statements made in the foregoing consent are true to the best of my knowledge and belief. DATED: __________________       Signature of Party       Printed Name       Address       City, State, and Zip       Telephone Number SUBSCRIBED AND SWORN to before me this day ______ of __________________ , 20 ______ . Notary Public My commission expires:       Type or Print Name Consent to Name Change Page 2 of 2