Proof Of Mailing Notice Of Petition For Change Of Name 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)

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

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

form/document

__________________________

Signature

PRO OF O F M AILIN G N OTIC E OF PETIT ION FOR CH AN GE O F NA ME - Page 2 of 2 FC(3/1/04)(F orm 7M)

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