PROBATE COURT OF SUMMIT COUNTY, OHIO IN THE MATTER OF CHANGING THE NAME: OF (Present Name) CASE NO. TO (Name Requested) AFFIDAVIT ON CHANGE OF NAME OF MINOR Now comes according to law, and hereby alleges as follows: G My relationship to is that of G The living parents of said minor are and G The Father Mother of said minor is deceased. . G The address of the Father, or alleged Father, is . G Reasonable diligence has been used to ascertain the unknown address , as follows: Postal Records Telephone Book City Directory Inquiry of Family/Neighbors Credit Bureau Auto Title Registration Board of Elections Other , being first duly sworn, , a minor, . . G The address of the Mother is G There is no person alleged to be the Father of said minor. Affiant STATE OF OHIO COUNTY OF SUMMIT Sworn to before me, and subscribed in my presence, this . day of , 20 Notary Public Form CN.1 American LegalNet, Inc. www.FormsWorkFlow.com