State of Minnesota County District Court Judicial District: Court File Number: Case Type: Name Change In the Matter of the Application of: First Middle Last On Behalf of: First Middle Last Affidavit in Support of Order for Publication and Order for Publication (Minor Name Change) (Minn. Stat. § 259.10, subd. 1) For a Change of Name to: First Middle Last ) ) SS ) STATE OF MINNESOTA COUNTY OF The undersigned applicant states that: 1. I have filed an Application for Name Change in _________________ County District Court for a change of name for the minor child (ren) from _____________________________ to __________________________________. A Notice of Hearing and copy of the Application for Name Change was mailed to the non-applicant parent at his/her last known address and was returned. An attempt at personal service of the Notice of Hearing and Application for Name Change was unsuccessful. I do not know the address of the non-applicant parent. The last known location of the non-applicant parent was: The last known location of the non-applicant parent's employment was: The names and addresses of the non-applicant parent's parents, brothers or sisters, children, and other close relatives are: 2a. 2b. 2c. 3. 4. 5. NAM207 State ENG Rev 4/05 www.mncourts.gov/forms American LegalNet, Inc. www.FormsWorkFlow.com Page 1 of 2 6. I have made the following efforts to get the non-applicant parent's address from these persons: Therefore, I request that the Court allow publication of the Notice of Hearing. I further request that the Court set a new hearing date, if necessary. I declare under penalty of perjury that everything I have stated in this document is true and correct. Minn. Stat. § 358.116. Date: Applicant Order for Publication Based on the above Affidavit, IT IS ORDERED: 1. Notice shall be given by publication once a week for three consecutive weeks in the legal newspaper of the county of the other parent's last known address. 2. The date and time of the Hearing on the Application for Name Change is at ____.m. at the following address: . 3. Applicant's request for publication is denied. Dated: Judge of District Court , NAM207 State ENG Rev 4/05 www.mncourts.gov/forms Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com