STATE OF INDIANA ) IN THE _____________ SUPERIOR/CIRCUIT COURT
)
SS:
COUNTY OF ______________ ) CASE
NO. ______________________________
IN RE THE NAME CHANGE OF: )
)
___________________________ )
Petitioner.
VERIFIED PETITION FOR CHANGE OF NAME
Petitioner, _____________________________, pro se,
respectfully petitions this Court to change
his/her/ name. In support of this Petition, Petitioner
states as follows:
1.
That my current name is: _____________________________________________________________.
2.
That I reside at:
_____________________________________________________________________.
3.
That pursuant to Indiana Code 34-28-2-1, I wish to change my name.
4.
That I am not seeking to defraud creditors by changing my name.
5.
That I have not been convicted of a felony within the last ten (10)
years.
6.
That I wish to change my name to :
____________________________________________________.
WHEREFORE, I respectfully request that this Court grant my Petition
for Name Change, and for all other just and proper relief. I affirm under the
penalties of perjury that the foregoing representations are true.
_____________________________
Signature
_____________________________
Print
your name
_____________________________
Mailing
address
_____________________________
Town,
State and Zip Code
_____________________________
Telephone
number, with area code
