Application For Change Of Name Of Minor (Trumbull) {21.2}

PROBATE COURT OF TRUMBULL COUNTY, OHIO JAMES A. FREDERICKA, JUDGE IN RE: CHANGE OF NAME OF__________________________________________________ TO ________________________________________________________________________ CASE NO. _______________________ (Name Requested) (Present Name) APPLICATION FOR CHANGE OF NAME OF MINOR [R.C. 2717.01] The applicant states that the applicant is the parent legal guardian guardian ad litem of the minor and that the minor has been a bona fide resident of ____________________________ County, Ohio, for at least one year immediately prior to the filing of this application. A certified copy of the minor's birth certificate is attached. The applicant states that the name and address of Parent 1 of the minor is: __________________________________________________________________________________ Name ___________________________________________________________________ Address __________________________________________________________________________________ City State Zip and the name and address of Parent 2 or alleged father of the minor is: __________________________________________________________________________________ Name ___________________________________________________________________ Address __________________________________________________________________________________ City State Zip Applicant states that the address of Parent 1 with reasonable diligence be ascertained. Parent 2 or alleged father is unknown and cannot There is no person alleged to be the father of the minor. The applicant states that the person for whom a change of name is being requested 1) _____ has has not been convicted of, pleaded guilty to, or been adjudicated a delinquent child for initials identity fraud. 2) _____ initials has a has no duty to comply with R.C. 2950.04 or R.C. 2950.041 because the applicant was convicted of, pled guilty to, or was adjudicated a delinquent child for having committed a sexually oriented offense or a child-victim oriented offense. FORM 21.2 ­ APPLICATION FOR CHANGE OF NAME OF MINOR Amended: March 15, 2016 Discard all previous versions of this form American LegalNet, Inc. www.FormsWorkFlow.com [Reverse of Form 21.2] CASE NO.______________ The applicant requests a change of name of the minor from _______________________________________ to ________________________________________________________________________________________ for the following reason: _______________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ The applicant states that the applicant will cause notice of the application to be published once in a newspaper of general circulation in this county at least thirty (30) days before the hearing on this application. In addition, notice will be given by the applicant to any non-consenting parent or alleged parent, whose addresses are known, by certified mail, return receipt requested. ______________________________________ Attorney for Applicant ______________________________________ Typed or Printed Name ______________________________________ Address ______________________________________ City State Zip ______________________________________ Telephone Number (include area code) Attorney Registration No. __________________ _____________________________________ Applicant's Signature _____________________________________ Typed or Printed Name _____________________________________ Address ______________________________________ City State Zip _____________________________________ Telephone Number (include area code) JOURNAL ENTRY SETTING HEARING AND ORDERING NOTICE The Court orders this application set for hearing on the _______ day of ___________,_____, at _______ o'clock ____.m. The applicant is ordered to cause notice of the application to be given by one publication in a newspaper of general circulation in this county at least thirty (30) days prior to the hearing date, as well as certified mail service, return receipt requested, if necessary, as required by law. ______________________________________ James A. Fredericka, Probate Judge By: _____________________________________ Deputy Clerk FORM 21.2 ­ APPLICATION FOR CHANGE OF NAME OF MINOR PAGE 2 Amended: March 15, 2016 Discard all previous versions of this form American LegalNet, Inc. www.FormsWorkFlow.com