DEKALB COUNTY SUPERIOR COURTSTATE OF GEORGIAIn re the Name Change of Child(ren): ,Petitioner,vs. ,Respondent.Civil Action Case Number PETITION TO CHANGE NAME(S)OF MINOR CHILD(REN)The Petitioner files this Petition to Change Name(s) of Minor Children, and statesthe following in support of the petition:1. The Petitioner222s name is , andshe or he resides in DeKalb County, Georgia. Therefore, jurisdiction and venue areproper in this Court.2.The Petitioner222s relationship to the children in this action is: [Check only one below.]G MotherG FatherG Guardian.Petition to Change Names of Minor Children 227 Rev. 10/24/01 - Tech. Rev. 10-2015 & 5-2017Page 1 of 4Provided by the DeKalb County Superior Court and the Atlanta Legal Aid Society American LegalNet, Inc. www.FormsWorkFlow.com 3.These are the current names, years of birth and proposed new names of thechild(ren) for whom the name change is sought:Current Name of ChildYear of BirthProposed New Name4.[Check only one of the following.]G The minor children live with the Petitioner in DeKalb County, Georgia. G The minor children do not live with the Petitioner. They live with in County, Georgia.5.[Explain here why you want to change the name(s).] The reasons for this name change are as follows: Petition to Change Names of Minor Children 227 Rev. 10/24/01 - Tech. Rev. 10-2015 & 5-2017Page 2 of 4Provided by the DeKalb County Superior Court and the Atlanta Legal Aid Society American LegalNet, Inc. www.FormsWorkFlow.com 6. The mother of the children is , her address is , and she: [You must check one (and only one) of the following.]GHas consented to this name change and has acknowledged service; the signedconsent and acknowledgment of service shall be filed with this Petition.GIs deceased.GHas abandoned the child(ren).GHas not contributed to the support of the child(ren) for a continuous period of atleast 5 years immediately preceding the filing of this Petition.7. The father of the children is , his address is , and he: [You must check one (and only one) of the following.]GHas consented to this name change and has acknowledged service; the signedconsent and acknowledgment of service shall be filed with this Petition.G Is deceased.G Has abandoned the child(ren).G Has not contributed to the support of the child(ren) for a continuous period of atleast 5 years immediately preceding the filing of this Petition.8. [You must check one (and only one) of the following.]G There is no legal guardian for these children, other than their parent(s).G Both parents are deceased or have abandoned the child(ren), and the guardian of the child(ren) is , whose address is ,and she or he has consented to this name change and has acknowledged service; thesigned consent and acknowledgement of service shall be filed with this Petition.THEREFORE, the Petitioner asks:(a)That the name(s) of the minor child(ren) be changed to the names shown inParagraph 3 of the petition.Petition to Change Names of Minor Children 227 Rev. 10/24/01 - Tech. Rev. 10-2015 & 5-2017Page 3 of 4Provided by the DeKalb County Superior Court and the Atlanta Legal Aid Society American LegalNet, Inc. www.FormsWorkFlow.com [Check one of the following methods of service for each person who must be served. Be sure to carefully read the instructions about service before you complete this part.]G (b)That the sheriff222s department personally serve the G mother G father G personacting as guardian of the minor children, whose address is shown above.G (c)That the G mother G father G person acting as guardian of the minor children beserved by certified mail, because they reside outside the state of Georgia.G (d)That the Court order service by publication for the G mother G father G personacting as guardian of the minor children, whose address is unknown. Dated: Petitioner, Pro se (Signature) Name: Address: Phone (day): ( ) Email: pro se Name chg child Petition - Tech rev 2015-102017-05.wpdPetition to Change Names of Minor Children 227 Rev. 10/24/01 - Tech. Rev. 10-2015 & 5-2017Page 4 of 4Provided by the DeKalb County Superior Court and the Atlanta Legal Aid Society American LegalNet, Inc. www.FormsWorkFlow.com