Fill and Sign the West Virginia Minor Form

IN THE ____________ COURT OF __________________ COUNTY WEST VIRGINIA IN THE MATTER OF:       Civil Action No. ______________ FOR A CHANGEOF NAME TO       CONSENT TO MINOR NAME CHANGE The undersigned _______________________________ and ___________________________ are the (check one) Mother Father Parents Guardian(s) of the above named minor child(ren). He has been advised that ____________________________ is filing a Petition in the Superior Court of __________________ County, Georgia, seeking to change the name(s) of the following child(r en) as follows: Current name(s) of minor child(ren) New name(s) of minor child(ren)       to             to             to             to             to             to       The undersigned hereby state that he has not abandoned said child(ren), nor has he failed to suppo rt the child(ren). The undersigned have been advised of the reasons for said name changes and the undersigned hereby consents to the filing of said Petition and to the aforesaid change of names.             Father Mother Guardian Father Mother Guardian Address:       Address:             Consent to Minor Name Change - 1 - VERIFICATION ________________________ __________________ County The undersigned does hereby state under oath that the facts contained within the attached Consent are true and correct and that said Consent was voluntarily given without coercion of any kind. Father Mother Guardian Father Mother Guardian (Sign in front of the Notary) (Sign in front of the Notary) Sworn to and subscribed before me Sworn to and subscribed before me this _________ day of _________ , ____ this _________ day of _________ , ____ Notary Public Notary Public Consent to Minor Name Change - 2 -