PROBATE COURT OF SHELBY COUNTY, OHIO IN THE MATTER OF _______________________________________________ CASE NO. ______________________ ENTRY The Court, on consideration of the evidence submitted, finds and orders that the setting and notice of a hearing be dispensed with in this matter; that the birth record of applicant be corrected in accordance with the facts set forth in the application; and that a certified copy of the order of the Court be forthwith transmitted to the Director of Health, at Columbus, Ohio, as provided by law. ________________________________ Probate Judge I hereby certify the above is a true copy of the entry. ________________________________ Probate Judge ________________________________ By: Deputy Clerk (SEAL) H.C. FORM 623.02 - ENTRY American LegalNet, Inc. www.FormsWorkFlow.com