Change Of Name General Judgement Page 2

Submitted by:

______________________________________

Attorney/Petitioner’s Name

Bar No. (if any)

______________________________________

Address

______________________________________

City

State Zip

Phone No.

______________________________________

Trial Attorney if other than above

Bar No.

Certificate of Document Preparation

If this document was not completed by an attorney, I hereby certify that the following statements

are true: (check all boxes and complete all blanks that apply)

A. G I selected this document for myself, and I completed it without paid assistance.

B. G I paid or will pay money to _________________ for assistance in preparing this

form/document

__________________________________

Signature

__________________________________

Print Name

CHANGE OF NAME GENERAL JUDGMENT - Page 2 of 2

(Form 15M) FC(11/20/08)

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Parent category: Legal