STATE OF INDIANA ) IN THE _____________ SUPERIOR/CIRCUIT COURT
)
SS:
COUNTY OF ______________ ) CASE
NO. ______________________________
IN RE THE NAME CHANGE OF: )
)
___________________________ )
Petitioner.
AFFIDAVIT OF PUBLICATION
I
hereby certify that the Notice of Suit entitled “Petition for Change of Name,”
was published three
(3) times, as prescribed by law,
in the _________________________________, a newspaper in the City of
________________________, County
of _________________________, Indiana,
on the following dates:
1.
_______________________, 200__;
2.
_______________________, 200__;
3.
_______________________, 200__.
I further certify that copies of the three said
Notices, designated as First, Second, and Third Notice
of Suit, respectively, and
the publisher’s affidavit regarding same, are hereto attached and made a part
of
this return.
I further
certify that the newspaper aforesaid met all legal requirements applicable to
such
publication.
_____________________________
Signature
_____________________________
Print
your name
_____________________________
Official
Title
_____________________________
Mailing
address
_____________________________
Town,
State and Zip Code
_____________________________
Telephone
number, with area code
