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CONSENT TO CHANGE NAME(S) OF MINOR CHILD(REN) COLUMBIA JUDICIAL CIRCUIT LAST UPDATED 10/17/2022 Page 1 of 2 IN THE SUPERIOR COURT OF COLUMBIA COUNTY STATE OF GEORGIA In re the Name Change of: * Child(ren): * CASE NUMBER: * * * Petitioner: * Respondent: * CONSENT TO CHANGE NAME(S) OF MINOR CHILD(REN) and ACKNOWLEDGMENT OF SERVICE 1. My name is and my address is (list street address, city, zip code and telephone number): 2. My relationship to the child(ren) in this action is: [Check ONE of the following]: ☐ Mother ☐ Father ☐ Guardian 3. I have received a copy of the Petition being filed by to change the name(s) of the children, and I hereby give my consent to the name(s) being changed as follows: Current Name of Child Year of Birth Proposed New Name ---PAGE BREAK--- CONSENT TO CHANGE NAME(S) OF MINOR CHILD(REN) COLUMBIA JUDICIAL CIRCUIT LAST UPDATED 10/17/2022 Page 2 of 2 4. I consent to both jurisdiction and venue as they are stated in the Petition. So long as any final order inthis action is consistent with this consent form, then I waive formal process, further notice, my right to a hearing and, if I am on active duty in the armed forces, I also waive my rights under the Soldiers and Sailors Civil Relief Act, 50 USC § 521. I give my consent for the Court to hear this matter without a jury and without notice to me anytime after the last day on which the filing of defensive pleadings would have been required. Should further notice be required for any reason, the notice should be mailed to me at the address shown in Paragraph One above. Date Parent/Guardian [Sign in front of notary] Appeared before me on this day of and stated under oath that he or she had read the foregoing document, understood it, and signed it voluntarily in my presence. Sworn to and subscribed before me This ___day Notary Public My Commission