Consent To Change Name {21.4}

PROBATE COURT OF LUCAS COUNTY, OHIO JACK R. PUFFENBERGER, JUDGE 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 2 capacities by which your consent is given] 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. Parent Sworn to before me and signed in my presence this ______ day of _______________,20 . Deputy Clerk/Notary Public FORM 21.4 - CONSENT TO CHANGE OF NAME Amended: March 15, 2016 Discard all previous versions of this form American LegalNet, Inc. www.FormsWorkFlow.com