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PETITION TO CHANGE NAME(S) OF MINOR CHILD(REN) LAST UPDATED 10/17/2022 Page 1 of 6 IN THE SUPERIOR COURT OF COLUMBIA COUNTY STATE OF GEORGIA In re the Name Change of: * Child(ren): * CASE NUMBER: * * * Petitioner: * Respondent: * PETITION TO CHANGE NAME(S) OF MINOR CHILD(REN) The Petitioner files this Petition to Change Name(s) of Minor Child(ren), and states the following: 1. The Petitioner’s name is and Petitioner resides in Columbia County, Georgia. Therefore, jurisdiction and venue are proper in this court. 2. The Petitioner’s relationship to the child(ren) in this action is: [Check ONE and ONLY ONE of the following]: ☐ Mother ☐ Father ☐ Guardian ---PAGE BREAK--- PETITION TO CHANGE NAME(S) OF MINOR CHILD(REN) LAST UPDATED 10/17/2022 Page 2 of 6 3. These are the current names, birthdates, and proposed new names of the child(ren) for whom the name change is sought: Current Name of Child Year of Birth Proposed New Name 4. [Check ONE and ONLY ONE of the following] ☐ The minor children live with the Petitioner in Columbia County, Georgia ☐ The minor children do not live with the Petitioner. They live with in County, Georgia. 5. [Explain why you desire the name change(s) in this section] The reasons for this name change are as follows: 6. The Mother of the child(ren) is Her address is (include street address, city, state, zip code and telephone number): ---PAGE BREAK--- PETITION TO CHANGE NAME(S) OF MINOR CHILD(REN) LAST UPDATED 10/17/2022 Page 3 of 6 and she: [Check ONE and ONLY ONE of the following] ☐ Has consented to this name change and has acknowledged service; the signed consent and acknowledgement of service shall be filed with this Petition. ☐ Is deceased. ☐ Has abandoned the child(ren). ☐ Has not contributed to the support of the child(ren) for a continuous period of at least 5 years immediately preceding the filing of this Petition. ☐ Is the Petitioner. 7. The Father of the child(ren) is His address is (include street address, city, state, zip code and telephone number): and he: [Check ONE and ONLY ONE of the following] ☐ Has consented to this name change and has acknowledged service; the signed consent and acknowledgement of service shall be filed with this Petition. ☐ Is deceased. ☐ Has abandoned the child(ren). ☐ Has not contributed to the support of the child(ren) for a continuous period of at least 5 years immediately preceding the filing of this Petition. ---PAGE BREAK--- PETITION TO CHANGE NAME(S) OF MINOR CHILD(REN) LAST UPDATED 10/17/2022 Page 4 of 6 ☐ Is the Petitioner. 8. [Check ONE and ONLY ONE of the following] ☐ There is no legal guardian for the child(ren), other than their parent(s). ☐ Both parents are deceased or have abandoned the child(ren) and the guardian of the child(ren) is whose address is (include street address, city, state, zip code and telephone number): and he or she has consented to this name change and has acknowledged service; the signed consent and acknowledgement of service shall be filed with this Petition. THEREFORE, the Petitioner asks That the name(s) of the minor child(ren) be changed to the name(s) shown in paragraph 3 of this Petition. [Check below ONLY if applicable] [If necessary party is in State and whereabouts are known, then in person service. If whereabouts are unknown, Petitioner must file an affidavit of diligent search, then can ask for service by publication.] ☐ That the Sheriff’s department personally serve the ☐ Mother ☐ Father ☐ Guardian of the minor child(ren) by certified mail, because they reside outside the State of Georgia. <> ---PAGE BREAK--- PETITION TO CHANGE NAME(S) OF MINOR CHILD(REN) LAST UPDATED 10/17/2022 Page 5 of 6 ☐ That the Court order service by publication for the ☐ Mother ☐ Father ☐ Guardian of the minor child(ren) whose address is unknown. Date PETITIONER [Sign in front of notary] Email Address: Sworn to and subscribed before me This ___day Notary Public My Commission ---PAGE BREAK--- PETITION TO CHANGE NAME(S) OF MINOR CHILD(REN) LAST UPDATED 10/17/2022 Page 6 of 6 IN THE SUPERIOR COURT OF COLUMBIA COUNTY STATE OF GEORGIA In re the Name Change of: * Child(ren): * CASE NUMBER: * * * Petitioner: * Respondent: * VERIFICATION I personally appeared before the undersigned Notary Public, and say under oath that I am the Petitioner in the above-styled action and that the facts stated in the corresponding Petition for Legitimation and Custody/Visitation are true and correct. Date PETITIONER [Sign in front of notary] Email Address: Sworn to and subscribed before me This ___day Notary Public My Commission