IN THE COURT OF COMMON PLEAS OF CHESTER COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION IN RE: {use initials only} Case Number: ___________________________ PETITION FOR ADULT ADOPTION WITH NAME CHANGE PRELIMINARY DECREE AND NOW, this __________ day of __________________________, ________, upon c onsideration of the within Pet as follows: (1) Hearing on the within Petiti on for Adoption with change of name ___________________ , _______, in request is fixed for ___________ at ___________ am/pm. (2) Chester County. (3) Proofs of publication of said no tice together with pr oof of official searches of the proper county offices shall be presented at the hearing. BY THE COURT: Notice of said propos ed change of name shall be publis hed one time in the Chester County Law Reporter and a newspaper of general c irculation in ition for Adoption and u pon Motion of ______________________________, Esquire, attorney for the Petitioner, it is Decreed ________________ before t he Honorable ________ __________________________, ______________________________________ J. American LegalNet, Inc. www.FormsWorkFlow.com