PROBATE COURT OF WOOD COUNTY, OHIO David E. Woessner, Judge In the Matter of the CHANGE OF NAME OF:_______________________________________________ (Present Name) To________________________________________________________________________________ (Name Requested) Case No. ______________________________ APPLICATION FOR CHANGE OF NAME OF ADULT (R.C. 2717.01) The Applicant states that the Applicant is an adult and has been a bona fide resident of Wood County, Ohio for at least one year immediately prior to the filing of this Application. The Applicant requests a change of name 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. The Applicant swears that the Applicant ( offense and ( is/ has has not ) been convicted of a sexually oriented is not ) required to register as a sex offender. _______________________________________________ Attorney for Applicant _______________________________________________ Applicant’s Signature _______________________________________________ Typed or Printed Name _______________________________________________ Applicant’s Address Address: _______________________________________ _______________________________________________ _______________________________________________ _______________________________________________ Applicant’s Phone Number _______________________________________________ Attorney Phone _______________________________________________ Attorney Registration Sworn to before me and subscribed in my presence this ______ day of _____________________, _______ (SEAL) __________________________________________________________________ Notary Public Signature __________________________________________________________________ Notary’s Printed Name and Commission Expiration Date FORM 800.A -- APPLICATION FOR CHANGE OF NAME OF ADULT 1/23/08 American LegalNet, Inc. www.FormsWorkflow.com