CV-471, 05/19 Order for Confidential Name Change 24724719.35(1), 786.36 and 786.37, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional materials. Page 1 of 2 Enter the name of the county in which this case was filed. STATE OF WISCONSIN, CIRCUIT COURT, COUNTY Enter the current name of the person whose name is proposed to be changed. IN THE MATTER OF THE CONFIDENTIAL NAME CH ANGE OF First Name Middle Name Last Name Amended Order for Confidential Name Change Case No. Enter the case number. Enter the county and the date of the hearing. The Petition for Confidential Name C hange was heard by the Circuit Court of County, Wisconsin on the day of , 20 . THE COURT FINDS: In 1, e nter the county name. 1. The person whose name is to be changed lives in County, Wisconsin . In 2, enter the name as it appears on the birth certificate. 2. The name that appears on the birth certificate is [First] [Middle] [Last] In 3, enter the name of the person whose name shall be changed. 3. The name of this person shall be changed to [First] [Middle] [Last] In 4 , enter the address. 4 . The address of the person whose name is to be changed is . In 5 , enter the date of birth. 5 . The date of birth of the person whose name is to be changed is . 6 . It has jurisdiction and notice of the hearing , if required, has been given. 7 . The facts of the P etition are true and correct. 8 . Publication of the P etition could endanger the person whose name is to be changed and the publication requirement is waived. 9 . The pe rson whose name is to be changed is not seeking a name change in order to avoid a debt or conceal a criminal record. In 10 , enter any other information. 10 . Other: American LegalNet, Inc. www.FormsWorkFlow.com CV-471, 05/19 Order for Confidential Name Change 24724719.35(1), 786.36 and 786.37, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional materials Page 2 of 2 STOP! The court will complete the rest of this form. THE COURT ORDERS: 1. The Petition for Confidential Name Change is granted. 2. If the person was born in Wisconsin, the Wisconsin birth certificate shall shall not b e changed. 3. If the person was married in Wisconsin, the Wisconsin marriage certificate shall shall not be changed. 4. remain confidential and are exempt from disclosure if a request to inspect or copy is made. 5. Other: DISTRIBUTION: 1. Court 2. Certified Copy - Register of Deeds 3. Petitioner American LegalNet, Inc. www.FormsWorkFlow.com