LORAIN COUNTY PROBATE COURT JUDGE JAMES T. WALTHER IN RE: CHANGE OF NAME OF ____________________________________________________________ (Present Name) To ______________________________________________________________________________________ (Name Requested) Case No. ________________________ APPLICATION FOR CHANGE OF NAME OF MINOR [R.C. 2717.01] The applicant states that the applicant is the parent legal guardian guardian ad litem of the minor and that the minor has been a bona fide resident of ____________________________ County, Ohio, for at least one year immediately prior to the filing of this application. A certified copy of the minor’s birth certificate is attached. The applicant states that the name and address of the mother of the minor is: _________________________________________________________________ Name ______________________________________________________________________________ Address ______________________________________________________________________________ City State Zip and the name and address of the father or alleged father of the minor is: ______________________________________________________________________________ Name ______________________________________________________________________________ Address ______________________________________________________________________________ City State Zip Applicant states that the address of the mother father or alleged father is unknown and cannot with reasonable diligence be ascertained. There is no person alleged to be the father of said minor. The applicant requests a change of name of the minor from __________________________________________________________ to ________________________________________________________________________________________________________ for the following reason: _____________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ FORM 21.2 - APPLICATION FOR CHANGE OF NAME OF MINOR 11/01/00 American LegalNet, Inc. www.FormsWorkFlow.com The applicant states that the applicant will cause notice of the application to be published once in a newspaper of general circulation in this county at least thirty (30) days before the hearing on this application. In addition, notice will be given by the applicant to any nonconsenting parent or alleged father, whose addresses are known, by certified mail, return receipt requested. _________________________________________________ Attorney for Applicant ___________________________________________________ Applicant's Signature _________________________________________________ Typed or Printed Name ___________________________________________________ Typed or Printed Name _________________________________________________ Address ___________________________________________________ Address _________________________________________________ City State Zip ____________________________________________________ City State Zip _________________________________________________ Telephone Number (include area code) _____________________________________________________ Telephone Number (include area code) Attorney Registration No. _____________________ JOURNAL ENTRY SETTING HEARING AND ORDERING NOTICE The Court orders this application set for hearing on the ____________ day of _______________________,______, at _________ o'clock ____.m. The applicant is ordered to cause notice of the application to be given by one publication in a newspaper of general circulation in this county at least thirty (30) days prior to the hearing date, as well as certified mail service, return receipt requested, if necessary, as required by law. _________________________________________________ JUDGE By: _________________________________________________ Deputy Clerk American LegalNet, Inc. www.FormsWorkFlow.com