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.	)

	CONSENT TO ACT AS NEXT FRIEND

I, JANE JONES, natural mother of JOHN DOE, hereby consents to be appointed next friend of JOHN DOE for the purposes of commencing and prosecuting this action for Change of Name.

___________________________________________
JANE JONES

DATED:__________________________________

STATE OF MISSOURI	)
)ss
COUNTY OF ________	)

SUBSCRIBED and SWORN to before me this _______ day of ________, 2009.

____________________________
Notary Public

My Commission Expires:_________________________.