PC-NC-21.0B (Rev. 5-2005) FRANKLIN COUNTY PROBATE COURT JUDGE ERIC BROWN LAWRENCE A. BELSKIS, JUDGE 373 SOUTH HIGH STREET, 22ND FLOOR COLUMBUS, OH 43215 NOTICE TO NAME CHANGE APPLICANTS Your hearing on your Application for Name Change has been set for the , 20 , at day of P.M. The hearing will be held in the Franklin County Probate Court, 22nd Floor, 373 S. High Street, Columbus, Ohio 43215. You must attend this hearing, and bring with you the following: (1) Proof of publication from a newspaper of general circulation, i.e., The Columbus Dispatch or The Daily Reporter; (2) If the name change is for a minor, please bring a certified copy of the minor’s birth certificate. (3) Consent of parent(s) or proof of service. It is your responsibility to publish the fact that you have filed the Application for Name Change and the hearing date. Publication is to be made in either: The Daily Reporter 580 S. High Street 3 rd Floor Columbus, OH 43215 Telephone Number 224-4835 Cost: $25.00 (Subject to Change) The Columbus Dispatch 34 S. Third Street Columbus, OH 43215 Telephone Number 461-5019 Cost: $3.62 per line Mon.-Sat. $5.16 per line Sunday (Subject to Change) The cost for publication is to be paid directly to the newspaper. A proof of publication will be furnished by either newspaper when payment is made. NOTICE: If the Name Change is for a minor the statute requires: When a name change of a minor is being considered, both the mother and father must either consent to the name change or be notified of the above hearing date by certified mail, return receipt requested. If you are either the mother or father and you know the address of the other parent you must notify, by certified mail return receipt requested, the other parent of the child and bring the green card to the hearing to prove notification. If you do not really know the address of the other parent and are unable to find it after a search, then you must complete the Affidavit contained in the name change package and testify under oath what efforts you have made to locate the other parent. The entire name change statute is on the following page for your information. TAKE THIS PAGE WITH YOU FRANKLIN COUNTY FORM 21.0B - NOTICE TO NAME CHANGE APPLICANTS American LegalNet, Inc. www.FormsWorkflow.com