IN THE COURT OF COMMON PLEAS DIVISION OF DOMESTIC RELATIONS LAKE COUNTY, OHIO ______________________________ ) CASE NO. __________________________ ) Plaintiff/Petitioner ) ) JUDGE COLLEEN A. FALKOWSKI vs./and ) ) ______________________________ ) ) Defendant/Petitioner ) ENTRY RESTORING FORMER NAME ) At the request of ___________________________[current name], the Court hereby ORDERS that __________________________________ be restored to the former name of _______________________________; Social Security Number _____________________ ; DOB _______________; and Current Address: __________________________________ _________. ______________________________________ COLLEEN A. FALKOWSKI, JUDGE ______________________________________ MAGISTRATE APPROVAL AND CC: ______________________________ ______________________________ 03/2005 American LegalNet, Inc. www.USCourtForms.com