FORM 21.0 226 APPLICATION FOR CHAN GE OF NAME OF ADULT (Page 1 of 2) Rev. 11/29/2016 PROBATE COURT OF SUMMIT COUNTY, OHIO ELINORE MARSH STORMER, JUDGE CASE NO. IN RE: CHANGE OF NAME OF (Present Name) TO (Name Requested) APPLICATION FOR CHANGE OF NAME OF ADULT [R.C. 2717.01] The applicant states that he or she is an adult and has been a bona fide resident of Summit County, Ohio, for at least one year immediately prior to the filing of this application. (A copy of his or her Birth Certificate and government issued valid photo ID are attached) The applicant requests a change of name from to for the following reason: The applicant states that he or she will cause notice of the application to be published once in a newspaper of general circulation in this county at least thirty (30) days before the hearing on this application. Applicant was born in , , . City County State The applicant states that the applicant 1) has has not been convicted of, pleaded guilty to, or being adjudicated a delinquent initials child for identity fraud. 2) has a has no duty to comply with R.C. 2950.04 or R.C. 2950.041 because the initials applicant was convicted of, pled guilty to, or was adjudicated a delinquent child for having committed a sexually oriented offense or a child-victim oriented offense. Attorney for Applicant222s Signature Applicant222s Signature Attorney for Applicant222s Typed or Printed Name Applicant222s Typed or Printed Name Address Address City State Zip City State Zip Telephone Number (include area code) Telephone Number (include area code) Attorney Registration No. American LegalNet, Inc. www.FormsWorkFlow.com FORM 21.0 226 APPLICATION FOR CHAN GE OF NAME OF ADULT (Page 1 of 2) Rev. 11/29/2016 CASE NO. ORDER SETTING HEARING AND ORDERING NOTICE The Court orders this application set for hearing on the day of , 20 , at o222clock .m. This hearing will be held in Probate Court, Summit County Courthouse, 209 South High Street, Akron, Ohio 44308. The person requesting the name change (Applicant) is responsible for publishing a notice of the hearing in the Akron Legal News at least 30 days before the hearing. If the hearing date is not published 30 days before the hearing, it will be continued. The Applicant must appear at the hearing and be prepared to show proof of reasonable and proper cause for the name change. IT IS SO ORDERED. JUDGE ELINORE MARSH STORMER By: Deputy Clerk American LegalNet, Inc. www.FormsWorkFlow.com