This form is approved by the Illinois Supreme Court and is required to be accepted in all Illinois Circuit Courts. NCM - AP 2006.2 Page 1 of 2 (0/18) STATE OF ILLINOIS , REQUEST FOR NAME CHANGE- ADDITIONAL PARENT 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 asking the court to change the names of minor children. First, Middle, Last Name Case Number DO NOT enter a Case Number, the Circuit Clerk will add it. TO CHANGE NAMES OF MINOR CHILDREN *Use this form only if you checked the "Yes" box in 7a or 7b on the Request for Name Change -Child Information* In 1, if there is another parent, list their name and address. If not, check none. 1. I am providing the following information about other parents ( do not include yourself or parents whose rights as parents have been terminated by a court order) . None Name and address of other parent: First Middle Last Street , Apt # City State ZIP In 2, if there is person who is not the parent with physical custody of the child, list their name and address. If not, check none. 2 . Person who is not the parent with physical custody of the child (do not include yourself) : None Name and address of person who is not the parent with physical custody of the child: First Middle Last Street , Apt # City State ZIP In 3, other people with legal rights to the child must receive written notice of your request to change the child222s name unless their rights have been terminated. Select the way that the other parent or person who is not the parent with physical custody of the child will receive notice . 3. The other parent or person who is not the parent with physical custody of the child: will receive notice of this Request and the scheduled court date by me by certified mail or service of process by sheriff; OR cannot be located and has received n otice of these proceedings by p ublication; OR had their parental rights terminated. American LegalNet, Inc. www.FormsWorkFlow.com Enter the Case Number given by the Circuit Clerk: NCM - AP 2006.2 Page 2 of 2 In 4, if the parent or person who is not the parent with physical custody of the child agrees to this name change, have them sign their name in front of an official Illinois notary public . 4 . The other parent or person who is not the parent with physical cust ody of the child agrees to this name change. I don't know No Yes (If yes, have the other parent sign below) I First Middle Last agree to the child222s name change. Signature (sign in front of an official Illinois notary public) DO NOT complete this section. The notary will complete it. Notary Public State of Illinois County Signed and sworn to before me by . D ate Name Seal Signature of Notary American LegalNet, Inc. www.FormsWorkFlow.com