Fill and Sign the Virginia Service Publication Form

IN THE CIRCUIT COURT OF THE CITY OF       , VIRGINIA IN RE: CHANGE OF NAME FOR MINOR CHILD No.       In the matter of the change of name of At Law             to             to             to             to       AFFIDAVIT FOR SERVICE BY PUBLICATION Comes now       Petitioner herein, seeking service on       the natural parent by ORDER OF PUBLICATION, and who under oath deposes and states under oath that the Natural Parent in this cause, 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 the last known mailing address of Natural Father/Mother is as follows: Name:       Address:             OTHER INFORMATION:       Explanation of circumstances:       __________________________________________ Signature of Petitioner _________________________________________ Counsel for Petitioner TO BE COMPLETED BY A NOTARY PUBLIC/OR DEPUTY CLERK In the Commonwealth/State of       In the County of:       Subscribed and sworn to before me by       this       day of       ,       . _________________________________ My Commission Expires:       Notary Public/Deputy Clerk 2