Clear Form
THE STATE OF NEW HAMPSHIRE
JUDICIAL BRANCH
http://www.courts.state.nh.us
Court Name: Case Name: Case Number:
(if known)
CONSENT TO MINOR NAME CHANGE
I,
Print name
, as
parent
guardian of the minor child,
consent to change the child's name from
(First, middle, last name)
to
(First, middle, last name)
Dated
Signature of person consenting to name change
Mailing Address
State of This instrument was acknowledged before me on My Commission Expires Affix Seal, if any
, County of by
Signature of Notarial Officer / Title
NHJB-2322-F (10/30/2006)
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