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PROBATE COURT OF SUMMIT COUNTY, OHIO ELINORE MARSH STORMER, JUDGE IN RE: CHANGE OF NAME OF TO CASE NO. (Present Name) (Name Requested) CONSENT TO CHANGE OF NAME The undersigned [check one of the following capacities by which your consent is given] Date of Birth Parent Alleged Father hereby waives notice of the hearing on the Application for Change of Name and consents to the change of name of to as proposed in the Application. Signature in the presence of Notary Sworn to before me and signed in my presence this day of , 20 . Deputy Clerk/Notary Public FORM 21.4 CONSENT TO CHANGE NAME American LegalNet, Inc. www.FormsWorkFlow.com Rev. 04/08/2016