Name Change Decree Form - Lake County, Illinois
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1IN THE CIRCUIT COURT OF THE NINETEENTH JUDICIAL CIRCUIT,
LAKE COUNTY, ILLINOIS
IN THE MATTER OF THE PETITION OF
)
)
_________________________________ )
)
Gen. No. _______________
_________________________________ )
)
F OR CHANGE OF NAME
)
DECREE
This cause having come on to be heard upon the Petition filed herein, and the Court having read said
Petition, together with the Affidavit appended thereto and the Certificate of Publication filed herein, and it
appearing that previous notice of the intended application for change of name was given by publishing a
notice thereof in the ______________________________________, a newspaper of general circulation
published in the county wherein said Petitioner resides, said publication having been made for three
consecutive
weeks,
the
first
insertion
of
which
was
at
least
six
weeks
prior
to
_________________________, 20____, being one of the return days of this Court, and said notice
being signed by the Petitioner, ____________________________________, setting forth the return day
of this Court at which said Petition was set for hearing, together with the name sought to be assumed;
and the Court, being fully advised in the premises, doth find:
That all material facts alleged in said Petition are true; that said Petitioner has been a resident of the
State of Illinois prior to the time of filing his / her Petition; that the conditions mentioned and specified in
735 ILCS 5/21 have been complied with, that this Court has jurisdiction of the Petitioner and the prayer in
the Petition should be granted.
IT IS THEREFORE ORDERED, ADJUDGED AND DECREED that said Petitioner’s name be changed
from __________________________________ to __________________________________ by which
last mentioned name, ____________________________________ shall be hereafter known and called.
ENTER:
_______________________________
JUDGE
Dated in Waukegan, Illinois
this _____ day of _________________________, 20_____.
CV/16
171-255
rev 10/05
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