PROBATE COURT OF CUYAHOGA COUNTY, OHIO Anthony J. Russo, Presiding Judge Laura J. Gallagher, Judge IN RE: CHANGE OF NAME OF (Present Name) TO: (Name Requested) CASE NO. CONSENT TO CHANGE OF NAME The undersigned [check one of the following 2 capacities by which your consent is given] Parent Alleged Father hereby waives notice of the hearing on the Application for Change of Name and consents to the change of name of to as proposed in the Application. Sworn to before me and subscribed in my presences this day of , 20 . Notary Public / Deputy Clerk FORM 21.4 ­ CONSENT TO CHANGE OF NAME OF MINOR Amended: 03/15/2016 Discard all previous versions of this form American LegalNet, Inc. www.FormsWorkFlow.com