IN THE CIRCUIT COURT OF THE NINETEENTH JUDICIAL CIRCUIT, LAKE COUNTY, ILLINOIS IN THE MATTER OF THE PETITION OF ) ) _________________________________ ) ) _________________________________ ) ) FOR CHANGE OF NAME ) Gen. No. _______________ DECREE This cause having come on to be heard upon the Petition filed herein, and the Court having read 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 change of name was given by publishing a notice thereof in the ______________________________________, a newspaper of general circulation published in the county wherein said Petitioner resides, said publication having been made for three consecutive weeks, the first insertion of which was at least six weeks prior to _________________________, 20____, being one of the return days of this Court, and said notice being signed by the Petitioner, ____________________________________, setting forth the return day of this Court at which said Petition was set for hearing, together with the name sought to be assumed; and the Court, being fully advised in the premises, doth find: That all material facts alleged in said Petition are true; that said Petitioner has been a resident of the State of Illinois prior to the time of filing his / her Petition; that the conditions mentioned and specified in 735 ILCS 5/21 have been complied with, that this Court has jurisdiction of the Petitioner and the prayer in the Petition should be granted. IT IS THEREFORE ORDERED, ADJUDGED AND DECREED that said Petitioner’s name be changed from __________________________________ to __________________________________ by which last mentioned name, ____________________________________ shall be hereafter known and called. ENTER: _______________________________ JUDGE Dated in Waukegan, Illinois this _____ day of _________________________, 20_____. CV/16 171-255 rev 10/05 American LegalNet, Inc. www.USCourtForms.com