Fill and Sign the Report of the Henry County Ohio Child Custody Ncjfcj Form

JDF 421 R3-18 PETITION FOR CHANGE OF NAME (MINOR CHILD) County Court District Court Denver Juvenile Court_________________________________ County, ColoradoCourt Address:In the Matter of the Petition of:Parent(s)/Petitioner(s):for:Minor Child:to change the child’s name to: COURT USE ONLY Attorney or Party Without Attorney (Name and Address): Phone Number: E-mail:FAX Number: Atty. Reg. #:Case Number:Division Courtroom PETITION FOR CHANGE OF NAME (MINOR CHILD) 1.Information regarding the minor child:Full Name of Minor Child(First, Middle and Last)Mailing AddressDate of Birth2. The minor child is a resident of County, Colorado.3.I/We______________________________________________ wish to change the name of the minor child to __________________________________ ________________ ___________________________________. First Name Middle Name Last Name My/Our relationship to the child is ___________________________________________________________. 4. The proposed change would be proper and not detrimental to the interests of any other person and in the best interest of the minor child.5.The reason for the change of name is _________ 6.The child is is not the subject of a child support, allocation of parental responsibilities, or parenting time action. If so, please identify (case number), (type of case) and (name of Court). 7. The minor child (if 14 years of age or older), has not been adjudicated as a juvenile delinquent for an offense that would constitute a felony if committed by an adult in this state or any other state or under federal law. The fingerprint- based criminal history record check for the minor child is attached as Exhibit A and is conducted within 90 days prior to the filing of this Petition .8.The required notice to the non-custodial parent has been accomplished by:  notice (JDF 422)  consent (JDF 423) or  request to publish (JDF 424) and is filed with this petition Not Applicable (There is no non-custodial parent)I/We, _____________________________ swear/affirm under oath that I have read the foregoing Petition and that the statements contained in this Petition are true to the best of my knowledge and belief. JDF 421 R3-18 PETITION FOR CHANGE OF NAME (MINOR CHILD)  By checking this box, I am acknowledging I am filling in the blanks and not changing anything else on the form. By checking this box, I am acknowledging that I have made a change to the original content of this form. VERIFICATION AND ACKNOWLEDGEMENT I swear/affirm under oath that I have read the foregoing Petition and that the statements set forth therein are true and correct to the best of my knowledge.___________________________________ ______________________________________ (Printed name of Petitioner ) Signature of Petitioner ________________________________________________________________________________________Petitioner’s Address City State Zip Code________________________________________________________________________________________(Area Code) Home Telephone Number Area Code) Work Telephone Number ____________________________________________________________________________________________________Signed and sworn to before me by _________________________________________in the County of _______________________, State of __________________, this _______, day of ________________, 20 ____.My Commission Expires: ___________________ _____________________________________ Deputy Clerk/Notary Public __________________________________________________________________________________________I swear/affirm under oath that I have read the foregoing Petition and that the statements set forth therein are true and correct to the best of my knowledge.___________________________________ _______________________________________(Printed name of Co-Petitioner) Signature of Co-Petitioner ________________________________________________________________________________________Co-Petitioner’s Address City State Zip Code________________________________________________________________________________________(Area Code) Home Telephone Number Area Code) Work Telephone Number Signed and sworn to before me by _________________________________________in the County of _______________________, State of __________________, this _______, day of ________________, 20 ____.My Commission Expires: ___________________ _____________________________________ Deputy Clerk/Notary Public