IN THE SUPERIOR COURT OF FULTON COUNTY STATE OF GEORGIA FAMILY DIVISION In re the Name Change of: Child(ren): Civil Action File No: Petitioner: and Respondent: CONSENT FORM The undersigned [1] and [2] the (check one)[3][ ] parents [ ] guardians of the following minor child(ren): [4] are . They have been advised that [5] is filing a Petition in the Superior Court of Fulton County, Georgia, seeking to change the name(s) of the following child(ren) as follows: [6] 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 they have not abandoned said child(ren), nor have they failed for a continuous period of five years or more to support 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. [7] ”Father ”Mother ” Guardian of _______________________________ Address: [8] ”Father ”Mother ” Guardian of Address: If you require materials in alternate format, please notify the Family Law Information Center as soon as possible. Consent Form-rev. 9/99 8 1999 Fulton County Superior Court Family Division Page 1 of 2 2000 (C) American LegalNet, Inc. VERIFICATION Georgia, Fulton 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 (Sign in front of the Notary) ”Father ” Mother ” Guardian (Sign in front of the Notary) Sworn to and subscribed before me this ________ day of ________, _____ Sworn to and subscribed before me this ________ day of ________, _____ _______________________________ Notary Public ________________________________ Notary Public If you require materials in alternate format, please notify the Family Law Information Center as soon as possible. Consent Form-rev. 9/99 8 1999 Fulton County Superior Court Family Division Page 2 of 2 2000 (C) American LegalNet, Inc.