PROBATE COURT OF MONTGOMERY COUNTY, OHIO ALICE O. McCOLLUM, JUDGE IN RE: CHANGE OF NAME OF ___________________________________________________ (Present Name) ________________________________________________________________________________________ (Name Requested) Case No. _______________________ NOTICE OF HEARING ON CHANGE OF NAME [R.C. 2717.01] Applicant hereby gives notice to all interested persons and to Necessary person whose address is unknown whose last known address is _________________________________________________________________ that the applicant has filed an Application for Change of Name in the Probate Court of Montgomery County, Ohio, requesting the change of name of ________________________________________________________ to ______________________________________________________________________________________. The hearing on the application will be held on the ____________ day of _______________________, 20____, at ________ o'clock ____M. in the Probate Court of Montgomery County, located at 41 North Perry Street, 2nd Floor, Dayton, Ohio 45422. __________________________________________________________ Applicant's Signature __________________________________________________________ Typed or Printed Name __________________________________________________________ Address __________________________________________________________ City State Zip Note to Publisher: The above legal notice including the caption is to be published once in its entirety. Costs are to be paid by applicant and an Affidavit of Publication is to be furnished to applicant. Eff. Date: January 1, 2010 FORM 21.5 ­ NOTICE OF HEARING ON CHANGE OF NAME American LegalNet, Inc. www.FormsWorkFlow.com