PROBATE COURT OF SUMMIT COUNTY, OHIO
IN THE MATTER OF CHANGING THE NAME: |
|
OF __________________________________ |
CASE NO. __________________________ |
(Present Name) |
|
TO __________________________________ |
|
(Name Requested) |
|
APPLICATION FOR CHANGE OF NAME OF MINOR
(R.C. 2717.01)
The applicant states that the applicant is the |
parent |
legal guardian |
guardian ad litem |
of the minor and that the minor has been a bona fide resident of Summit County, Ohio, for at least one year immediately prior to the filing of this application. A certified copy of the minor’s birth certificate is attached.
The applicant states that the name and address of the mother of the minor is:
___________________________________________________________________
Name
___________________________________________________________________
Address
___________________________________________________________________
and the name and address of the father or alleged father of the minor is:
___________________________________________________________________
Name
___________________________________________________________________
Address
___________________________________________________________________
CityStateZip
Applicant states that the address of the |
mother |
father or alleged father is unknown and |
cannot with reasonable diligence be ascertained.
There is no person alleged to be the father of said minor.
The applicant states that the person for whom a change of name is being requested
1) ____ has (not) been convicted of, pleaded guilty to, or been adjudicated a delinquent child for identity fraud.
Initials
2)____ has (no) duty to comply with ORC 2950.04 or ORC 2950.041 because the applicant was convicted of, Initials pleaded guilty to or was adjudicated a delinquent child for having committed a sexually oriented offense
or a child-victim oriented offense.
The applicant requests a change of name of the minor from ______________________________________
to _____________________________________ for the following reason: __________________________
_____________________________________________________________________________________
_____________________________________________________________________________________.