4348 - Order to Change Name 4349 - Order Vital Statistics to Issue Corrected Birth Certificate (Rev. 12/12/14) CCDR N058 IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS COUNTY DEPARTMENT, DOMESTIC RELATIONS DIVISION ______________________________________________________ Petitioner v. ______________________________________________________ Respondent Docket No. _____________________________ ORDER THE COURT HAVING JURISDICTION OVER THE SUBJECT MATTER AND ALL NECESSARY PARTIES, IT IS HEREBY ORDERED THAT: The child born on ____________________ to the Petitioner/Respondent ________________________________ Petitioner/Respondent _______________________________________ has been know as __________________. The name of the child is hereby changed to ________________________________. The Bureau of Vital Statistics is hereby directed to issue a corrected birth certificate, changing the name of the child from ____________________________to ________________________. adding the name of the Petitioner/Respondent ________________________________________. ENTERED: Dated: _______________________, _______ Judge Judge's No. DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS Page 1 of 1