PRINT in BLACK ink Enter the name of the county in which this case was filed. STATE OF WISCONSIN, CIRCUIT COURT, COUNTY In the matter of the name change of: For Official Use Enter the current name of the person whose name is proposed to be changed. ___________ (First, Middle, Last name) ____ (as it currently appears on the birth certificate) Enter Petitioner’s and Co-Petitioner’s (if any) name(s) if the name change is for a minor under 14 years of age. Enter the case number on the far right. By: (Petitioner) _________________ First Name Middle Name(s) Last Name Amended By: (Co-Petitioner) _________________ First Name Middle Name(s) Last Name Notice and Order for Name Change Hearing Case No. NOTICE IS GIVEN THAT: Enter the name as it currently appears on the/your birth certificate of the person whose name is proposed to be changed. Enter the proposed new name. A petition has been filed asking to change the name of the person listed above: From: First Name Middle Name(s) Last Name To: First Name Middle Name(s) Last Name IT IS ORDERED: This petition will be heard in the Circuit Court of Wisconsin: Judge’s Name: Place: County, State of The court will enter the judge’s name, county, place, date and time for the name change hearing. If you need help in this matter because of a disability, please call: Date: Time: IT IS FURTHER ORDERED: Note: Enter the name of the newspaper and the county. You must publish this notice in the newspaper as ordered here. Notice of this hearing shall be given by publication as a Class 3 notice for three (3) weeks in a row prior to the date of the hearing in the a newspaper published in County, State of Wisconsin. BY THE COURT: For Court Use Only. Circuit Court Judge Signature Print or Type Name Date Notice to Printers: Do not print the instructional text in the boxes along the left-hand column when publishing this notice. Print bolded text in bold typeface. CV-460, 04/08 Notice and Order for Name Change Hearing §786.36, Wisconsin Statutes Page 1 of 1 This form shall not be modified. It may be supplemented with additional materials.
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