Form DC-6:11(3) "Consent for the Name Change of a Minor Child" - Nebraska

Form DC-6:11(3) or the "Consent For The Name Change Of A Minor Child" is a form issued by the United States District Court for the District of Nebraska.

Download a PDF version of the Form DC-6:11(3) down below or find it on the United States District Court for the District of Nebraska Forms website.

ADVERTISEMENT

Download Form DC-6:11(3) "Consent for the Name Change of a Minor Child" - Nebraska

1121 times
Rate
(4.5 / 5) 78 votes
Nebraska State Court Form
CONSENT FOR THE NAME
CHANGE OF A MINOR CHILD
DC 6:11(3)
Rev. 05/15
Neb. Rev. Stat. § 25-21, 271
IN THE DISTRICT COURT OF _____________________ COUNTY, NEBRASKA
(county were Petition filed)
IN RE NAME CHANGE OF
CASE No.___________________
(case number assigned by clerk of court)
________________________________
CONSENT FOR THE NAME
(minor child(ren)’s current full name(s))
CHANGE OF A MINOR CHILD
________________________________
________________________________
________________________________,
Minor Child(ren), By Next Friend,
________________________________.
(your full name)
State of
)
) ss.
County of
)
I, _______________________________, being first duly sworn, state as follows:
(consenting parent’s full name)
1.
I am the
mother
father of ________________________________,
______________________________________________________________________
(minor child(ren)’s current full name(s))
minor child(ren) born _____________________________________________________.
(minor child(ren)’s year(s) of birth)
2.
I hereby freely and voluntarily and not as a result of any threat or promise,
consent to the name change of my minor child(ren) _____________________________
______________________________________________________________________
(minor child(ren)’s current full name(s))
Page 1 of 2
Consent for the Name Change of a Minor Child
DC 6:11(3) Rev. 05/15
Nebraska State Court Form
CONSENT FOR THE NAME
CHANGE OF A MINOR CHILD
DC 6:11(3)
Rev. 05/15
Neb. Rev. Stat. § 25-21, 271
IN THE DISTRICT COURT OF _____________________ COUNTY, NEBRASKA
(county were Petition filed)
IN RE NAME CHANGE OF
CASE No.___________________
(case number assigned by clerk of court)
________________________________
CONSENT FOR THE NAME
(minor child(ren)’s current full name(s))
CHANGE OF A MINOR CHILD
________________________________
________________________________
________________________________,
Minor Child(ren), By Next Friend,
________________________________.
(your full name)
State of
)
) ss.
County of
)
I, _______________________________, being first duly sworn, state as follows:
(consenting parent’s full name)
1.
I am the
mother
father of ________________________________,
______________________________________________________________________
(minor child(ren)’s current full name(s))
minor child(ren) born _____________________________________________________.
(minor child(ren)’s year(s) of birth)
2.
I hereby freely and voluntarily and not as a result of any threat or promise,
consent to the name change of my minor child(ren) _____________________________
______________________________________________________________________
(minor child(ren)’s current full name(s))
Page 1 of 2
Consent for the Name Change of a Minor Child
DC 6:11(3) Rev. 05/15
to ____________________________________________________________________
______________________________________________________________________.
(minor child(ren)’s preferred new name(s))
Date
Consenting Parent’s Signature (your signature)
Consenting Parent’s Full Name
Consenting Parent’s Full Street Address/P.O. Box
Consenting Parent’s City/State/ZIP Code
Consenting Parent’s Phone
Consenting Parent’s E-mail Address
, this
The foregoing instrument was acknowledged before me by
(Name of person certifying above)
day of
,
.
Notary Public (signature of person taking acknowledgment)
Year
Month
Day
My commission expires:
(title or rank)
(serial number, if any)
Page 2 of 2
Consent for the Name Change of a Minor Child
DC 6:11(3) Rev. 05/15
ADVERTISEMENT
Page of 2