This form is approved by the Illinois Supreme Court and is required to be accepted in all Illinois Circuit Courts. NC - WNM 306.1 Page 1 of 2 (01 /1 9 ) STATE OF ILLINOIS , MOTION TO WAIVE NOTICE & PUBLICATION (REQUEST FOR NAME CHANGE) For Court Use Only CIRCUIT COURT COUNTY Instructions Directly above, enter the county name where you will file this case. REQUEST OF : Enter the name of the person requesting the name change. ( First, middle, last name ) Case Number DO NOT enter a Case Number, the Circuit Clerk will add it. You can only use this form if: you believe that notice or publication will put the person whose name would be changed at risk of physical harm or discrimination; OR you have or have previously been granted a protective order. 1. I am filing a Request for Name Change for myself or my children. 2. I am seeking a waiver of the notice and publication requirement. 3. I need this waiver because (check 3a or 3b and all other box es that appl y ) : a. notice and publication of the name change would put the person whose name would be changed at risk of physical harm and/or discrimination because: In 3, check all boxes that apply. If none apply to you, you cannot use this form. If you check 3a, describe how notice or publication would put you at risk. If you check 3b, also check which type of orders you have or had to protect you. b. I have or did have protection granted by : Order of Protection; Stalking No Contact Order ; Attach copies of the orders and any other documents that support your claim to this Motion. Civil No Contact Order ; Protective Order in someone else's criminal case; B een a protected person under someone else222s bail conditions ; OR Similar protective order in another state: American LegalNet, Inc. www.FormsWorkFlow.com Enter the Case Number given by the Circuit Clerk: NC - WNM 306.1 Page 2 of 2 ( 01 /1 9 ) In 4, enter the information about the protective orders. 4. If you checked any boxes in 3(b) , complete the following about the protective orders: County State Case No. Under the Code of Civil Procedure, 735 ILCS 5/1-109 , making a statement on this form that you know to be false is perjury, a Class 3 Felony. I certify that everything in the Motion is true and correct. I understand that making a false statement on this form is perjury and has penalties provided by law under 735 ILCS 5/1 - 109 . /s/ Your Signature Street Address If you are completing this form on a computer, sign your name by typing it. If you are completing it by hand, sign and print your name. Print Your Name City, State, Zip Telephone Enter your complete current address and telephone number. If disclosing your address would put you or your household at risk, you may use another address. That address must be one at which you can receive mail about the case. I am using an alternative address because disclosing my address would put me or my household at risk. American LegalNet, Inc. www.FormsWorkFlow.com