In The Circuit Court For The Seventh Judicial Circuit of Illinois Sangamon County, Springfield, lilinois IN THE MATTER OF THE PETITION OF Case No. _ FOR CHANGE OF NAME TO PETITION FOR CHANGE OF NAME Now comes your Petitioner, -:-:---.c-----=--------,--.---...,,-----------' and prays that this Honorable COUli grant the relief and states as grounds there for: I. That your Petitioner desires a change of name according to the provisions of 735 ILCS 5/21 - 101. 2. That your petitioner was born on the day of , 20 , and has been a resident of the State of Illinois and the County of Sangamon for more than six months preceding the filing of the Public Notice required herein. 3. The reasons which the Petitioner request the change of name are: 4. That the person whose name is to be changed has not been convicted of any felony or any misdemeanor criminal sexual abuse, misdemeanor sexual exploitation of a child, or misdemeanor indecent solicitation of a child or adult. 5. That Petitioner's native state or Country is, _ 6. That Petitioner's present residence is, _ 7. If a minor, the non-custodial parent is~ who resides at _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ and has filed a consent or can be notified at said address. American LegalNet, Inc. www.FormsWorkflow.com In The Circuit Court For The Seventh Judicial Circuit of Illinois Sangamon County, Springfield, Illinois WHEREFORE, your Petitioner respectfully prays: A 111at my name be changed from its present form to, as provided by Statute. _ B. That the official custodian of the State Registrar of Vital Records of the State oflllinois be ordered and directed to amend the original certificate of my birth to reflect that said name has been and will in the to, _ future be changed from pursuant to and in compliance with 735 ILCS 512 I -1 OJ etseq. (Guardian if petitioner is a Minor) VERIFICA nON STATE OF ILLINOIS COUNTY OF SANGAMON -;;----;;----:-,----__,___--~c-.,,_-__,______:;:__:c:c:____c;;---c-;----:;::;;-beingirst duly sworn under oath, deposes and says f that Petitioner has read the foregoing Petition for Name Change, by Petitioner subscribed herein, and that the facts set forth are true. (Guardtan tf petItioner IS a Mmor) Subscribed and sworn to before me this ~, .day of 20_ _ (Notary Public) Form CV90 [2-\ 0 American LegalNet, Inc. www.FormsWorkflow.com In The Circuit Court For The Seventh Judicial Circuit of Illinois Sangamon County, Springfield, Illinois IN THE MATTER OF THE PETITION OF Case No. ~ _ FOR CHANGE OF NAME TO DECREE AND ORDER OF CHANGE OF NAME This cause having come on to be heard upon the Petition filed herein and upon the motion ofthe Petitioner and the court having read such Petition and the certificate of the publication filed herein, and it appearing that previous notice of intended application for a change of name was given by publishing a notice in the'---_ -=----=c--c--.,-;-----:--:-:-----:,----:----,--:--~, a newspaper of general circulation published in Sangamon County, JIIinois; said publication having been made for three consecutive weeks, the first insertion of which was at least six weeks prior to the day of , 20 , being one of the return days of this court, and all required notices have been given and the Court being fully advised the premised Finds: 1. That all material facts alleged in said Petition are true. 2. 11]at said Petitioner is a resident of the State ofJllinois and has resided therein, continuously for a period of at least six months next preceding the _ _day of , 20__. 3. That the conditions of 735 lLCS 5/21-1 OJ etseq. have been complied with in all respects and that a change of name is in the best interest of the Petitioner. 4. That this Court has the jurisdiction ofthe person and subject matter hereof, and that no reason appears why the prayer and said Petition should not be granted. WHEREFORE, it is hereby Ordered and Decreed: A. That said Petitioner's name be, and the same is hereby changed from _ _ _ _ _ _ _ _ _ _ _ _ _ _ _~. to _ _ B. That the official custodian of State Registrar and State Register of Vital Records of the State of JIIinois shall be and hereby is Ordered to amend the original certificate of birth to reflect the change of Petitioner's name and transfer a copy of the Amended Birth Certificate to the Petitioner, pursuant to and m compliance with 735 ILCS 5/21-101 etseq. Entered this _ _day of ~. 20,_ _ Judge American LegalNet, Inc. www.FormsWorkflow.com