PROBATE COURT OF _______________ COUNTY, OHIO IN RE: CHANGE OF NAME OF ____________________________________________________________ (Present Name) To ______________________________________________________________________________________ (Name Requested) Case No. ________________________ JUDGMENT ENTRY - CHANGE OF NAME OF ADULT On _______________________________________ an application for change of name was heard by this Court. The Court 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 cause exists for changing the name. The Court finds that the applicant's complete name at birth was _______________________________________________________, applicant's date of birth was ______________________________________________________________, and the place of birth was ____________________________________________________________________________________________________________ City County State Therefore, it is ORDERED the name of __________________________________________________________________________ be changed to _______________________________________________________________________________________________ __________________________________________________ Probate Judge CERTIFICATION OF JUDGMENT ENTRY The above Judgment Entry - Change of Name of Adult is a true copy of the original kept by me as custodian of the records of this Court. Probate Judge/Clerk By ______________________________________________ Deputy Clerk _________________________________________________ Date FORM 21.1 - JUDGMENT ENTRY - CHANGE OF NAME OF ADULT American LegalNet, Inc. www.FormsWorkFlow.com 11/01/00 Print Form