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ACKNOWLEDGMENT OF SERVICE NAME CHANGE REQUEST—COLUMBIA JUDICIAL CIRCUIT LAST UPDATED 10/17/2022 Page 1 of 1 IN THE SUPERIOR COURT OF COLUMBIA COUNTY STATE OF GEORGIA , * PLAINTIFF, * * CASE NUMBER: v. * * , * DEFENDANT. * ACKNOWLEDGMENT OF SERVICE WITH NAME CHANGE REQUEST The undersigned Defendant hereby acknowledges due and legal service of the Complaint for Divorce in the above-styled case, acknowledges receipt of a copy thereof, and hereby waives any and all further notice, service, and issuance of summons. [Check and/or complete ONLY if applicable] ☐ The undersigned Defendant consents to the above-styled case being tried by the Court without a jury and without notice any time after the last day on which the filing of defensive pleadings would have been required. [used when the parties desire the Divorce to be final as soon as possible] ☐ The undersigned Defendant is the wife. She requests that the Court restore her former name so that after the divorce decree is entered by the Court, her complete legal name will be: FIRST MIDDLE LAST DATE DEFENDANT [Sign in front of notary/judge] Address Telephone Number Sworn and subscribed before me E-Mail Address: This day of , . NOTARY PUBLIC/JUDGE SUPERIOR COURT (if Notary) My Commission Expires: