IN THE CIRCUIT COURT OF {COUNTY NAME} COUNTY, MISSOURI

JOHN DOE, by his next friend,
JANE JONES	)
{STREET ADDRESS}	)
{CITY}, MO  {ZIP},	)
	)
	)	CASE NO. ____________________
	)
PETITIONER.	)

	JUDGMENT UPON PETITION FOR NAME CHANGE

On this ____ day of __________, 2009, the Petition of JOHN DOE, by his next friend, JANE JONES for Change of Name comes on to be heard, and after fully examining said Petitioner, as to the reason for said desired name change, it is found that said name change is proper and that it will not be detrimental to the interest of any persons.
It is, therefore, ordered, adjudged and decreed that the name of JOHN DOE, born {DATE OF BIRTH}, be changed to that of JOHN JONES.

__________________________________________
JUDGE OF THE ASSOCIATE CIRCUIT COURT