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PROBATE COURT OF CUYAHOGA COUNTY, OHIO …

PROBATE COURT OF CUYAHOGA county , ohio . ANTHONY J. RUSSO, PRESIDING JUDGE. LAURA J. GALLAGHER, JUDGE. IN RE: CHANGE OF NAME OF. (Present Name). TO. (Name Requested). CASE NO. APPLICATION FOR CHANGE OF NAME OF ADULT. [ ]. The applicant states that the applicant is an adult and has been a bona fide resident of CUYAHOGA county , ohio , for at least one year immediately prior to the filing of this application. The applicant requests a change of name 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. The applicant states that the applicant 1) has has not been convicted of, pleaded guilty to, or been adjudicated a delinquent child for Initials identity fraud.

FORM 21.0 – APPLICATION FOR CHANGE OF NAME OF ADULT Amended: January 1, 2013 Discard all previous versions of this form PROBATE COURT OF CUYAHOGA COUNTY, OHIO

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Transcription of PROBATE COURT OF CUYAHOGA COUNTY, OHIO …

1 PROBATE COURT OF CUYAHOGA county , ohio . ANTHONY J. RUSSO, PRESIDING JUDGE. LAURA J. GALLAGHER, JUDGE. IN RE: CHANGE OF NAME OF. (Present Name). TO. (Name Requested). CASE NO. APPLICATION FOR CHANGE OF NAME OF ADULT. [ ]. The applicant states that the applicant is an adult and has been a bona fide resident of CUYAHOGA county , ohio , for at least one year immediately prior to the filing of this application. The applicant requests a change of name 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. The applicant states that the applicant 1) has has not been convicted of, pleaded guilty to, or been adjudicated a delinquent child for Initials identity fraud.

2 2) has has no duty to comply with or R. C. because the applicant was Initials convicted of, pled guilty to, or was adjudicated a delinquent child for having committed a sexually oriented offense or a child-victim oriented offense. Attorney for Applicant Applicant's Signature Typed or Printed Name Typed or Printed Name Address Address City State Zip City State Zip Telephone Number (include area code) Telephone Number (include area code). Attorney Registration No. FORM APPLICATION FOR CHANGE OF NAME OF ADULT Amended: January 1, 2013 Discard all previous versions of this form (Reverse of Form ). JUDGMENT 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 required by law.

3 PROBATE Judge By: Deputy Clerk FORM APPLICATION FOR CHANGE OF NAME OF ADULT. (PAGE 2). Amended: January 1, 2013. Discard all previous versions of this form INFORMATION REGARDING ADULT NAME CHANGE APPLICATIONS. DOCUMENTS REQUIRED to FILE: Application to Change Name (Adult) (Form ). (Typed applications preferred to ensure correct spelling.). Copy of the applicant's Birth Certificate Non-English certificates MUST be accompanied by a professional translation Birth Certificate Information Form (attached to Application Form packet). FILING OF APPLICATION: Upon the acceptance of the above documents, together with your Application for an Adult Name Change, your Application will be assigned a Judge and Case Number. It will then be forwarded to the scheduling department where a date and time for your COURT appearance will be scheduled.

4 The hearing date is scheduled at a minimum of six (6). weeks from the date of filing to allow for PUBLICATION of your Application required by State law. The PROBATE COURT will provide for the PUBLICATION of your Application; no action is required of you. Within 3-5 business days, you will be notified by regular Mail of the assigned Magistrate and date and time of your hearing. If upon receiving your hearing date and time you have a scheduling conflict, please call 216-443-8979 to reschedule. The COURT will make every effort to accommodate a convenient date and time for all parties concerned. PLEASE BE PREPARED FOR YOUR HEARING: Applicants MUST present valid photo identification at the hearing. Bring any of the required supplemental documents, if for any reason they were not submitted at the time of initial filing.

5 The completed BIRTH CERTIFICATE. INFORMATION FORM should be in your file and verified with the Deputy Clerk at the time of check-in for the hearing. PLEASE BE ADVISED: That any incorrect information or any changes made to your Application after the initial filing date, and once PUBLICATION has commenced, MAY delay the COURT 's proceedings. If your Application needs to be AMENDED for any reason, there may be an additional $ charge which may result in a later hearing date and republication of the AMENDED Application. ADDITIONAL INFORMATION: If your Application is granted, you will receive your certified copies of the COURT 's Order granting your name change via regular Mail within 7-10 business days. It is your responsibility to notify any pertinent agencies of your new name. If you wish to obtain an AMENDED ohio BIRTH CERTIFICATE, contact the Bureau of Vital Statistics ( ohio Department of Health): 1-614-466-2531.

6 Rev. 11/2/17. Birth Certificate Information Form PLEASE PRINT ALL INFORMATION. *No Abbreviations*. Case Number COMPLETE Original Name on Birth Certificate: Date of Birth: City of Birth: county of Birth: State of Birth: Country of Birth: Current Legal Signature of Applicant: (Sign the name you are legally using now).


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