MARK J. BARTOLOTTA, JUDGE PROBATE COURT OF LAKE COUNTY, OHIO 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 3 capacities by which your consent is given] Mother Father Alleged Father hereby waives notice of 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 signed in my presence this _____ day of ____________________________, ________ ____________________________________ Deputy Clerk/Notary Public Print Reset American LegalNet, Inc. www.FormsWorkFlow.com