Fill and Sign the Virginia Order Publication Form

IN THE CIRCUIT COURT OF ______________ COUNTY, VIRGINIA IN RE: CHANGE OF NAME FOR MINOR CHILD No. ________________ FROM: _________________________ TO: ____________________________ ORDER OF PUBLICATION The reason for this cause is to obtain name change of minor child An affidavit having been made and filed showing that the Natural Parent in the above-entitled cause is Is a non-resident individual, other than a non-resident individual fiduciary who has appointed a statutory agent; OR Cannot be found, and that diligence has been used without effect to ascertain the location of the party to be served; OR Cannot be served with court process, and that a return has been filed by the Sheriff which shows that the process has been in his or her hands for twenty-one (21) days and the Sheriff has been unable to make service; OR OTHER: _________________________________________________________________________ and last known mailing address of Natural Father/Mother is as follows: Name: ____________________________________________ Address: ____________________________________________ ____________________________________________ TO BE COMPLETED BY CLERK'S OFFICE Upon consideration, this Order of Publication is granted, and it is ORDERED that the above named Natural Parent shall appear here on or before _______ day of _____________________ , _______ after proper publication of this Order, to protect his/her interest in this cause. ENTERED: _______________________ TESTE: _________________, CLERK BY: ____________________________ DEPUTY CLERK ____________________________________ Signature of Petitioner or Counsel for Petitioner Address: ______________________________ ______________________________ Phone Number: ___________________