PROBATE COURT OF STARK COUNTY, OHIO DIXIE PARK, JUDGE IN RE: CHANGE OF NAME OF_________________________________________________ (Present Name) TO ________________________________________________________________________ (Name Requested) CASE NO. ___________ JUDGMENT ENTRY - CHANGE OF NAME OF MINOR On _____________________________________an application for change of name was heard by this Court. The Court finds that proper notice of the application and hearing date was given by one publication in a newspaper of general circulation in this county at least thirty days prior to the hearing on the application and proper notice was given to the legal parents, known parent, or alleged parent, as required by law. The Court further finds that reasonable and proper cause exists for changing the name and the name change is in the best interest of the minor. The Court finds the minor's complete name at birth was _______________________________________________, the minor's date of birth was _____________________________________________________, and the place of birth was _______________________________________________________________________________________________ City County State Therefore, it is ORDERED the name of _______________________________________________________________ be changed to ________________________________________________________________________________________ __________________________________ Dixie Park - Probate Judge CERTIFICATION OF JUDGMENT ENTRY The above Judgment Entry - Change of Name of Minor is a true copy of the original kept by me as custodian of the records of this Court. Dixie Park - Probate Judge/Clerk By ________________________________ Deputy Clerk _________________________________ Date FORM 21.3 - JUDGMENT ENTRY - CHANGE OF NAME OF MINOR Amended: March 15, 2016 Discard all previous versions of this form American LegalNet, Inc. www.FormsWorkFlow.com