IN THE CIRCUIT COURT FOR THE SIXTEENTH JUDICIAL CIRCUIT DE KALB COUNTY, ILLINOIS IN THE MATTER OF THE PETITION OF ) ) No. __________________ ___________________________________________) DECREE FOR CHANGE OF NAME This cause having come on to be heard upon the petition filed herein and upon motion of petitioner's attorney, and the Court having read the said petition, together with the affidavit appended thereto, and the certificate of publication filed herein, and it appearing that previous notice of the intended application for a change of name was given by publishing a notice thereof in ___________________________________, a newspaper of general circulation published in the county therein the said petitioner resides, said publication having been made for three consecutive weeks, the first insertion of which was at least six weeks prior to ________________________, _____, the said petition being signed by the said petitioner and setting forth the return day of the Court at which the said petition was to be filed, together with the name sought to be assumed, and the Court, being fully advised in the premises, doth find: That all the material facts alleged in said petition are true; that the said petitioner is a resident of the State of Illinois and has resided therein continuously for a period of at least six months next preceding ____________________, 20___, that the conditions mentioned and specified in an Act of the General Assembly of the State of Illinois, entitled "An Act to Revise the Law in Relation to Names," approved February 25, 1874, and in force July 1, 1874, and as amended, have been complied with; that this Court has jurisdiction of the persons and of the subject matter hereof; and that no reason appears why the prayer in said petition contained should not be granted. IT IS THEREFORE ORDERED, ADJUDGED AND DECREED that the said petitioner's name be, and the same is hereby changed from ________________________________ _____________________________________________________________________________ to __________________________________________________________________________ by which said last-mentioned name shall be hereafter known and called. ENTER: Judge DATE: Name Attorney for petitioner – Attorney number Address City/State/Zip Telephone C:\FORMS\CI000034.CIV Rev.: 7/7/06 American LegalNet, Inc. www.FormsWorkflow.com