Form 21.1 - Judgment Entry - Change Of Name Of Adult
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1PROBATE COURT OF _______________ COUNTY, OHIO
IN RE: CHANGE OF NAME OF ____________________________________________________________
(Present Name)
To ______________________________________________________________________________________
(Name Requested)
Case No. ________________________
JUDGMENT ENTRY - CHANGE OF NAME OF ADULT
On _______________________________________ an application for change of name was heard by this Court. The Court finds that
proper notice of the application and hearing date was given by one publication in a newspaper of general circulation in this county at least
thirty days prior to the hearing on the application. The Court further finds that reasonable and proper cause exists for changing the name.
The Court finds that the applicant’s complete name at birth was _______________________________________________________,
applicant’s date of birth was ______________________________________________________________, and the place of birth was
____________________________________________________________________________________________________________
City
County
State
Therefore, it is ORDERED the name of __________________________________________________________________________
be changed to _______________________________________________________________________________________________
__________________________________________________
Probate Judge
CERTIFICATION OF JUDGMENT ENTRY
The above Judgment Entry - Change of Name of Adult is a true copy of the original kept by me as custodian of the records of this
Court.
Probate Judge/Clerk
By ______________________________________________
Deputy Clerk
_________________________________________________
Date
FORM 21.1 - JUDGMENT ENTRY - CHANGE OF NAME OF ADULT
11/01/00
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