Probate Court Form 123 Petition To Change Name Of Minor Page 2
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2Being over the age of 14, I consent to the name change:
___________________________
Minor
At ____________________on this _____day of ______________, 20__,
personally appeared before me and acknowledged this instrument,
by him/her subscribed, to be his/her free act and deed.
______________________________________
Judge/Register
That I [ ] do [ ] do not wish to change the birth certificate.
Part II. Consent
I,_________________, whose relationship with the minor is that of
__________________consent to the change of name of the minor from
____________________to the new name of _________________________.
Dated at ______ this ____ day of ___________, 20__.
Signed ___________________________
Print Name _______________________
Address __________________________
__________________________________
__________________________________
Tel: (___) _______________________
___________________________________________
Notary Public - My commission expires on ______________________________.
Note: 15 V.S.A. ' 812 states
that Athe name of a minor if
over fourteen years of age,
shall not be changed without
his consent given in court.@
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