Order Changing Name Of Minor Page 2
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1
2Case No.__________________________
4.
This Order does not release the minor child or either parent named above from any obligations
incurred or harm any rights of property or action in any original name.
5.
Other orders:* ___________________________________________________________________
* (May NOT use to establish paternity or add name of a father to birth certificate.)
DONE IN OPEN COURT:
Date
Judicial Officer
Page 2 of 2
Revised: 12/31/2009
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