Fill and Sign the Sc Change Form

STATE OF SOUTH CAROLINA ) IN THE FAMILY COURT OF THE )       JUDICIAL CIRCUIT COUNTY OF       ) ) ORDER AND CERTIFICATE OF ) NAME CHANGE AND EX PARTE: ) AMENDMENT OF BIRTH ) CERTIFICATE       ) Plaintiff ) Docket No.       I find that (1) this Court has jurisdiction over this matter pursuant to Section 20-7-420(8) & (9), Code of Laws of South Carolina, 1976, as amended; (2) the party is entitled and not in any way disqualified to have his/her name changed; (3) that the applicable provisions of Section 15- 49-10, Code of Laws of South Carolina, 1976, as amended, have been complied with; and, (4) that the following reasons exist for the change of name:                   I further find that the following information appears on the birth certificate of the party whose name is to be changed:             Full Name at Birth Full Name of Father             Date of Birth Full Maiden Name of Mother       Birthplace: County and State IT IS, THEREFORE, ORDERED that the name of the party be changed and may be so reflected in the birth certificate of the party. From       To       Date:       PRESIDING JUDGE       JUDICIAL CIRCUIT Plaintiff’s Address             - 1 -