FRANKLIN COUNTY PROBATE COURT ROBERT G. MONTGOMERY, JUDGE LAWRENCE A. BELSKIS, JUDGE Present Name Name Requested PC-NC-21.3 (Rev. 12-2000) IN RE: CHANGE OF NAME OF TO CASE NO. JUDGMENT ENTRY - CHANGE OF NAME OF MINOR On an application for change of name was heard by this Court. The Court finds that proper notice of the application and hearing date was given by one publication in a newspaper of general circulation in this county at least thirty days prior to the hearing on the application and proper notice was given to the legal parents, known father, or alleged father, as required by law. The Court further finds that reasonable and proper cause exists for changing the name and the name change is in the best interest of the minor. The Court finds that the minors complete name at birth was the minors date of birth was , , and the place of birth was . City County State Therefore, it is ORDERED the name of be changed to . Signature Page Attached LAWRENCE A. BELSKIS Robert G. Montgomery, Judge Judge CERTIFICATION OF JUDGMENT ENTRY The above Judgment Entry - Change of Name of Minor is a true copy of the original kept by me as custodian of the records of this Court. ROBERT G. MONTGOMERY LAWRENCE A. BELSKIS Probate Judge/Clerk By Deputy Clerk Date FORM 21.3 - JUDGMENT ENTRY - CHANGE OF NAME OF MINOR 11-1-00 American LegalNet, Inc. www.FormsWorkFlow.com