Georgia-- Consent To Change of Name of Minor

About this Form: The following consent form may accompany the Petition for "Change of Name of Minor" if required by State law. Please make contact with the court clerk in your county (in which the minor lives) to find out whether or not this particular "Consent To Change of Name of Minor" is needed.

State of Georgia County of _____________	Court ______________________ Docket No. _________________
Name of Petitioner(s):	In re:  Change of Name of Minor
_____________________________	From: _____________________________ To: _____________________________

I make the following declaration:

1. Name:  My name is _________________________, and as of the date of the signing of this Consent, I have always been known by that name, with the following exceptions, if any:
_____________________________________________________
_____________________________________________________
_____________________________________________________

2. Residence:  I reside at _________________________ [insert the residential address] and have lived at this address for _______ [insert length of time in months or years at this address].

3. Consent to Change of Name of Minor:  I am fully informed of the legal consequences and effects, and I give my consent to the request of the Petitioner(s) to change the name of said minor child as follows:

From: _____________________________________ To: _______________________________________

Verification

I, ___________________________ [name of individual granting his or her consent], affirm under penalty of perjury that all statements in this Consent to Change of Name of Minor are accurate to the best of my knowledge.
 

___________________________________________	_________________
Signature	Date
_____________________________________________ Address, Line 1 _____________________________________________
Address, Line 2

Subscribed and sworn to before me on this ____ day of _______, 20___.


_________________________________
Notary