IN THE WARREN COUNTY, OHIO COMMON PLEAS COURT PROBATE DIVISION IN RE: CHANGE OF NAME OF (Present Name) T O (Name Requested) C ASE NO. DECISION OF MAGISTRATE - CHANGE OF NAME OF A DULT On an application for change of name was heard by this Court. The C ourt 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 . The Court further finds that reasonable and proper ca use exists for changing the name. The Court finds the complete name at birth was , the date of birth was , and the place of birth wa s City County State Therefore, it is ORDERED the name of b e changed to Probate Magistrate CERTIFICATION OF DECISION OF MAGISTRATE The above Decision of Magistrate Change of Name of Adult is a true copy of the original kept by me as custodian of the records of this Court. P robate Judge/Clerk By Deputy Clerk Date FORM 21. 1 .A DECISION OF MAGISTRATE - CHANGE OF NAME OF ADULT 11/01/00 American LegalNet, Inc. www.FormsWorkFlow.com