EX PARTE
IN THE MATTER OF
THE PETITION OF Civil No.______
Nathaniel Carlton Furbert
I SOLEMNLY affirm under the penalties of perjury that the contents of the
foregoing are true and correct to the best of my knowledge , information , and belief.
______________________________
Nathaniel C. Furbert
IN THE CIRCUIT COURT FOR ____________________, MARYLAND
EX PARTE
IN THE MATTER OF
THE PETITION OF Civil No.______
Nathaniel Carlton Furbert
COMES NOW the Petitioner , Nathaniel Carlton Furbert , who deposes under
oath and penalties of perjury in support of the Petition for Name Change and in support
of the Motion for Notice by Posting, and states as follows:
1. I am over the age of 18, and I am the Petitioner in these proceedings, and I have
personal knowledge of the facts stated in the Petition for Change of Name filed with the
Court.
I SOLEMNLY affirm under the penalties of perjury that the contents of the
foregoing are true and correct to the best of my knowledge , information and belief .
_______________________________
Nathaniel Carlton Furbert
STATE OF MARYLAND
CITY OF BALTIMORE
On this _____ day of __________ , 20___ , before me , a Notary Public in and for
the State and County aforesaid, personally appeared ____________________ in the
above-entitled cause, who executed the aforegoing Affidavit and made oath in due form
of law, under penalties of perjury, that the facts and statements contained in this Affidavit
are true and correct and that (he/she) acknowledged to me that (he/she) freely and
voluntarily executed the same for the purpose named therein.
_____________________________
Notary Public
EX PARTE
IN THE MATTER OF
THE PETITION OF Civil No.______
Nathaniel Carlton Furbert
ORDERED, that notice of the Petitioner’s Petition for Change of Name be posted
pursuant to Maryland Rule 2-122 .
_______________________________
JUDGE, Circuit Court for
____________________ , Maryland
IN THE CIRCUIT COURT FOR ____________________, MARYLAND
EX PARTE
IN THE MATTER OF
THE PETITION OF Civil No.______
Nathaniel Carlton Furbert
to
Nathaniel Carlton Fortier
_______________________________
JUDGE, Circuit Court for
____________________ , Maryland
IN THE CIRCUIT COURT FOR ____________________, MARYLAND
EX PARTE
IN THE MATTER OF
THE PETITION OF Civil No.______
Nathaniel Carlton Furbert
ORDER
This is to give notice that on this ____ day of _______________ , 20____ , a Petition
for Change of Name was filed in the Circuit Court for _________________________ ,
Maryland . The Petition states in substance that Nathaniel Carlton Furbert was born
on March 23, 1970 and now lives at 1203 Windemere Avenue, Baltimore, Maryland
21218 . The Petitioner wishes to change his name from Nathaniel Carlton Furbert
to Nathaniel Carlton Fortier .
_______________________________
JUDGE, Circuit Court for
____________________ , Maryland