PROBATE COURT OF MONTGOMERY COUNTY, OHIO ALICE O. MCCOLLUM, JUDGE IN RE: CHANGE OF NAME OF ______________________________________________________ (Present Name) TO ________________________________________________________________________________ (Name Requested) CASE NO.: _________________________________________________________________________ JUDGMENT ENTRY - CHANGE OF NAME The undersigned Judge has reviewed the Magistrate's Decision set forth above and finds said decision to have no clear errors of law or fact and hereby adopts this decision as the order of this Court. Therefore, it is ORDERED that the name of _________________________________________ _____________________________, whose date of birth is __________________, and place of birth is ________________________________________________ is changed to _______________________ ___________________________________________. A copy of the Magistrate's Decision and Judge's Order has been hand delivered to the applicant. _____________________________________ Probate Judge CERTIFICATION OF JUDGMENT ENTRY The above Judgment Entry ­ Change of Name is a true copy of the original kept by me as custodian of the records of this Court. _____________________________________ Probate Judge/Clerk By: _____________________________________ Deputy Clerk _____________________________________ Date M.C. FORM 21.1. ­ JUDGMENT ENTRY ­ CHANGE OF NAME 04/08/2011 American LegalNet, Inc. www.FormsWorkFlow.com