State of Wisconsin

Circuit Court

Burnett County

In the Matter of the name change of

Madelyn Jean Belisle

Notice and Order for Name Change Hearing

Case No. 19CV100

Notice is given:

A Petition was filed asking to change the name of the person listed above:

From: Madelyn Jean Belisle

To: Madelyn Jean Iwaszko

Birth Certificate: Madelyn Jean Belisle

It is Ordered:

This Petition will be heard in the Circuit Court of Burnett County, State of Wisconsin before Judge Mellisia Mogen at the Burnett County Government Center in Siren, WI on August 2, 2019 at 8:45 am.

It is further ordered:

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 Burnett County Sentinel, a newspaper published in Burnett County, State of Wisconsin.

By the Court

/s/ Melissa R. Mogen

Circuit Court Judge

July 2, 2019

WNAXLP

(July 10, 17, 24)