PROBATE COURT OF _______________ COUNTY, OHIO
IN RE: CHANGE OF NAME OF ________________________________________________________
(Present Name)
To __________________________________________________________________________________
(Name Requested)
Case No. ________________________
CONSENT TO CHANGE OF NAME
The undersigned ______________________________________________________________________________________ [check one of the following 3 capacities by which your consent is given] Mother Father Alleged Father hereby waives notice of the hearing on the Application for Change of Name and consents to the change of name of ____________________________________________________________________________________________________ to __________________________________________________________________________________________________ as proposed in the Application.
__________________________________________
Sworn to before me and signed in my presence this _____ day of __________________________________, ____________
__________________________________________ Deputy Clerk/Notary Public
FORM 21.4 - CONSENT TO CHANGE OF NAME
11/01/00