Form 21.2 - Application For Change Of Name Of Minor - Probate Court Of Summit County
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PROBATE COURT OF SUMMIT COUNTY, OHIO
ELINORE MARSH STORMER, JUDGE
CASE NO.
IN RE: CHANGE OF NAME OF
(Present Name)
TO
(Name Requested)
APPLICATION FOR CHANGE OF NAME OF MINOR
[R.C. 2717.01]
The applicant states that I am 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 (1) year immediately prior to the filing of
this application.
A copy of the minor’s birth certificate and applicant’s government issued valid photo ID are attached.
The applicant states that the name and address of Parent 1 of the minor is:
Name
Address
City
State
Zip
and the name and address of
Parent 2 or alleged
father of the minor is:
Name
Address
City
State
Zip
Applicant states that the address of the
Parent 1
Parent 2
or father or alleged father is
unknown and cannot with reasonable diligence be ascertained.
There is no person alleged to be the father of the minor.
The applicant states that the person for whom a change of name is being requested
1)
has a
has not been convicted of, pleaded guilty to, or been adjudicated a delinquent child
for identity fraud.
initials
2)
has a
has no duty to comply with R.C. 2950.04 or R.C. 2950.041 because the applicant was
convicted of, pled guilty to, or was adjudicated a delinquent child for having committed a sexually
initials
oriented offense or a child-victim oriented offense.
FORM 21.2 – APPLICATION FOR CHANGE OF NAME OF MINOR
Page 1 of 2
Rev. 02/02/2017
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