(A Translation of an original at my best knowledge)
November 22 nd 1995, Serge Joseph Adrien Lacombe, born June 20 Th. 1957, in Verdun, Quebec and who have is domicile and resident at 103 Oxford Crescent, Lennoxville, had address a request to the Director of the Civil State in the purpose to change his name in the one of Serge Bourassa-Lacombe, Conformably to the articles 58 and following of Civil Code of Quebec (L.Q., 1991, Chapter 64).
The applicant had furnish, to sustain of his demand, the proof of publications of advice requested by the article 5 of Regulation relative of changing of name and others qualities of the Civil State;
The request, the declaration under swear of the applicant, and the pieces was produce to the file;
Considering that the applicant was register, in the Parish Notre-Dame-des-Sept-Douleurs, under the patrimony «Lacombe», Like the one of his father;
Considering the desire from the applicant to add to his family name the patrimony «Bourassa», like the one of his mother, in the purpose to permit him to be distinguish from persons who have the same name as him;
Considering that conformability to the article 58 of Civil Code of Quebec, the Director of the Civil State had competency to authorize the change of name for serious reasons;
Considering that the change of name can be accord when the one who own it know worries and problems sufficient graves who will be attenuates, see eliminates, by his changing name;
Considering that the applicant had demonstrate, to the satisfaction of the Director of the Civil State, that he had a serious motive to change his name;
Considering that conformability to the article 51 of Civil Code of Quebec, the attributed name to a person is the one of his father or of his mother or a composite name of at plus two parts original from family name of the one of those;
Considering that the Director of the Civil State gave himself as politic to rejoin the composite name by a hyphen, a manner to eliminate all confusion on the identity of the person;
Considering that none opposition, objection or observation was not bring into the Twenty (20) days who had follow November 11 th 1995, date of the last of publications or advises prescribe by the law;
THOSE MOTIVES, the Director of the Civil State,
AUTHORIZE the change of name of «Serge Joseph Adrien Lacombe» in the one of «Serge Joseph Adrien Bourassa-Lacombe»;
DECREEING that the born act of the applicant be modify in consequence.