(First Published in _______________________________[Name of News Publication], _______________, 20____ ) IN THE DISTRICT COURT OF JUDICIAL DISTRICT COUNTY, KANSAS IN THE MATTER OF THE PETITION OF Case No. _____________ Present Name Div. No. ______________ To Change His/Her Name to: New Name PURSUANT TO K.S.A. CHAPTER 60 NOTICE OF HEARING - PUBLICATION THE STATE OF KANSAS TO ALL WHO ARE OR MAY BE CONCERNED: You are hereby notified that ______________________________________ [Petitioner’s Full Name], filed a Petition in the above court on the ____ day of ________________________, 20_____, requesting a judgment and order changing his/her name from ____________________ ____________________________ to ______________________________________________ . The Petition will be heard in _________________________ County District Court, _______________________________________ [Court address], ______________________ [City], Kansas, on the ____day of ________________, 20_______, at ____:____ G a.m. G p.m. If you have any objection to the requested name change, you are required to file a responsive pleading on or before __________________, 20_____ [Insert date at least 41 days after first publication] in this court or appear at the hearing and object to the requested name change. If you fail to act, judgment and order will be entered upon the Petition as requested by Petitioner. _________________________________________ Petitioner, Pro Se Name (Print):______________________________ Address 1: ________________________________ Address 2: ________________________________ City, State, Zip: ____________________________ Telephone Number: ________________________ KSJC 12/2010 Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com