SUPERIOR COURT OF THE DISTRICT OF COLUMBIA WASHINGTON, DC 20001 [ ] CIVIL DIVISION [ ] FAMILY COURT In re: _____________________________________________ Case NO. __________________ APPLICANT’S FULL NAME ORDER OF PUBLICATION Pursuant to SCRͲ205 and D.C. Code 16Ͳ2501, 2502 and 2503 _______________________________________________________ having filed a complaint for judgment changing ___________________________________________________ name to ______________________________________________ and having applied to the court for an Order of Publication of the notice required by law in such cases; and it is by the Court this _____ day of ____________________________ 20___, hereby ORDERED, that all persons concerned show cause, if any there be, on or before the _____ day of _____________________________ 20____, why the prayers of said complaint should not be granted; provided that a copy of this Order be published once a week for three (3) consecutive weeks before said day in the ___________________________________ newspaper. PROVIDED FURTHER: (Check all that applies, if applicable) [ ] that pursuant to SCRͲ205(b) notice be sent to the applicant’s creditors by registered or certified mail and that proof of service of mailing be made in the manner provided in SCR Probate Rule 19(b). [ ] that pursuant to SCRͲ205(b) notice be sent to the D.C. Chief of Police and to the Department of Corrections by registered or certified mail and that proof of service of mailing be made in the manner provided in SCR Probate Rule 19(b). [ ] that pursuant to SCRͲ205(b) notice be sent to the Bankruptcy Court by registered or certified mail and that proof of service of mailing be made in the manner provided by SCR Probate Rule 19(b). [ ] that Immigration and Customs Enforcement Agency, Washington Field Office, 2675 Prosperity Avenue, Fairfax, Virginia 22031, by registered or certified mail and that proof of service of mailing be made in the manner provided in SCR Probate Rule 19(b). SO ORDERED. _______________________________________ JUDGE NOT VALID WITHOUT A RAISED SEAL Revised January 2011 American LegalNet, Inc. www.FormsWorkFlow.com