CASE No. (case number assigned by lerk of ourt)IN RE NAME CHANGE OF (minor child(ren)current full name(s)) ,Minor Child(ren), By Next Friend, .(your full name) I, , being first duly sworn, state as follows: 1.I am the mother father of , current full name(s))minor child(ren) born . (minor child(ren)(s) of birth) 2.I hereby freely and voluntarily and not as a result of any threat or promise, consent to the name change of my minor child(ren) current full name(s)) IN THE DISTRICT COURT OF COUNTY, NEBRASKA (county were Petition filed) State of ) ) ss. County of ) American LegalNet, Inc. www.FormsWorkFlow.com Date Name Consenting ParentStreet Address/P.O. Box City/State/ZIP Code -mail Address (title or rank)The foregoing instrument was acknowledged before me by , this Name of person certifying above day of , . DayMonthYear Notary Public (signature of person taking acknowledgment) My commission expires: (serial number, if any) to .(minor child(ren)new name(s)) American LegalNet, Inc. www.FormsWorkFlow.com