Free CCDR 0058 3-10-08.pmd - Illinois

4348 - Order to Change Name 4349 - Order Vital Statistics to Issue Corrected Birth Certificate Order IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS COUNTY DEPARTMENT, DOMESTIC RELATIONS DIVISION (3/10/08) CCDR 0058

______________________________________________
Petitioner v.

______________________________________________
Respondent

}

Docket No. _______________________

ORDER
THE COURT HAVING JURISDICTION OVER THE SUBJECT MATTER AND ALL NECESSARY PARTIES, IT IS HEREBY ORDERED THAT:

The child born on _______________________, ________ to the mother ______________________________ and the father ______________________________ has been known as ______________________________. The name of the child is hereby changed to ______________________________.

The Bureau of Vital Statistics is hereby directed to issue a corrected birth certificate, changing the name of the child from ________________________________ to

______________________________.
adding the name of the father ______________________________.

ENTERED:

Dated: _____________________________, __________

___________________________________________
Judge Judge's No.

DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS