VIRGINIA: IN THE CIRCUIT COURT OF THE CITY OF VIRGINIA BEACH IN RE: MOTION FOR RESTORATION OF FORMER NAME OR MAIDEN NAME CHANGED BY REASON OF A MARRIAGE PURSUANT TO § 20-121.4 DIVORCE CASE NO.: INSERT COURT CASE NUMBER ORDER RESTORING FORMER NAME This matter came before the court on the motion of insert requesting party’s full current name to resume a former name changed by reason of a marriage. The applicant’s birth name was insert full birth name and has been changed as follows: insert former name changes in a “from” “to” format, including all name changes as a result of marriage. The applicant’s current address is: insert full street address. The applicant requests the restoration of her former name of: insert full former name requesting name change to. Accordingly, the Court ORDERS that the name of insert requesting party’s current full name be changed to her former name of insert full former name. The clerk of court shall spread this order upon the current deed book and index it in both the old and new names pursuant to § 8.01-217 and the party shall pay the clerk’s recording fee required by statute. ENTER: _________________________ ________________________________ JUDGE I ASK FOR THIS: ___________________________________ Signature of Applicant/Counsel ___________________________________ Printed Name of Applicant/Counsel American LegalNet, Inc. www.FormsWorkflow.com