IN THE CHANCERY COURT FOR DAVIDSON COUNTY, TENNESSEE IN RE: NAME CHANGE OF MINOR _____________________________________ ____________________________________ By Next Friend (Both Parents): ________________________________________ Name of Mother ________________________________________ Date of Birth of Mother ________________________________________ Name of Father ________________________________________ Date of Birth of Father Name Date of Birth Docket No. _____________ ORDER It appears to the Court as evidenced by the verified petition, sworn testimony, and exhibits in this matter that the Petitioner, by and through the child's best friends, wishes to change his/her name from ____________________________________________________ to ____________________________________________________________________________, and that it further appearing that change is not made for any fraudulent purpose or for any illegal or improper purpose whatsoever. IT IS, THEREFORE ORDERED, ADJUDGED and DECREED that the full and Complete name of the above named minor child shall be ________________________________ and Further, that the Tennessee Department of Health, Bureau of Vital Statistics, change the name of the Minor child on his/her birth certificate, No. ___________________, from ________ _____________________________ to ____________________________________________. ___________________________________ CHANCELLOR/JUDGE American LegalNet, Inc. www.FormsWorkFlow.com American LegalNet, Inc. www.FormsWorkFlow.com