FORM 21.2 226 APPLICATION FOR CHANGE OF NAME OF MINOR Page 1 of 2 Rev. 0 3/12/ 2018 PROBATE COURT OF SUMMIT COUNTY, OHIO ELINORE MARSH STO R MER, JUDGE IN RE: CHANGE OF NAME OF (Present Name) CASE NO. TO (Name Requested) APPLICATION FOR CHANGE OF NAME OF MINOR [R.C. 2717.01] The applicant states that the applicant is the parent legal guardian guardian ad litem of the minor and that the applicant has been a bona fide resident of Summit County, Ohio for at least one (1) year immediately prior to the filing of this application. A copy of the minor222s birth certificate and applicant222s government issued valid photo ID are attached. The applicant states that the name and address of Parent 1 of the minor is: Name Address City State Zip and the name and address of Parent 2 or alleged father of the minor is: Name Address City State Zip Applicant states that the address of the Parent 1 Parent 2 or father or alleged father is unknown and cannot with reasonable diligence be ascertained. There is no person alleged to be the father of the minor. The applicant states that the person for whom a change of name is being requested 1) has has not been convicted of, pleaded guilty to, or been adjudicated a delinquent child initials for identity fraud. 2) has a has no duty to comply with R.C. 2950.04 or R.C. 2950.041 because the applicant was Initials convicted of, pled guilty to, or was adjudicated a delinquent child for having committed a sexually oriented offense or a child-victim oriented offense. American LegalNet, Inc. www.FormsWorkFlow.com FORM 21.2 226 APPLICATION FOR CHANGE OF NAME OF MINOR Page 2 of 2 Rev. 0 3/12/ 2018 CASE NO. Minor was born in , , City County State The applicant requests a change of name of the minor from to for the following reason: The applicant states that the applicant 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. In addition, notice will be given by the applicant to any non-consenting parent or alleged father, whose addresses are known, by certified mail, return receipt requested. 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. JOURNAL ENTRY 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.as well as certified mail service, return receipt requested, if necessary, as required by law. 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