STATE OF INDIANA COUNTY OF (Select One) ) IN THE (Select One) ) SS: ) CASE NO. SUPERIOR/CIRCUIT COURT IN RE THE NAME CHANGE OF: ) ) ) ) Petitioner. ) APPEARANCE 1. Petitioner: ___________________________________________________________ 2. Attorney Information: 3. Case Type: MI 4. Will NOT accept FAX service. 5. Are there related cases? Self-Represented Case Number(s): ______________________________________________________________ _____________________________________ Signature Form #PS-34282-1 Approved by State Court Administration 05/09 Page 2 of 6 American LegalNet, Inc. www.FormsWorkFlow.com