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Order On Verified Petition For Change Of Name Form. This is a Indiana form and can be use in Family Law (Pro-Se) Statewide.
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Tags: Order On Verified Petition For Change Of Name, Indiana Statewide, Family Law (Pro-Se)
STATE OF INDIANA
COUNTY OF
)
IN THE
) SS:
)
CASE NO.
CIRCUIT COURT
IN RE THE NAME CHANGE OF: )
)
)
)
Petitioner.
)
ORDER ON VERIFIED PETITION FOR CHANGE OF NAME
On ________________, Petitioner, _______________________________________________,
appeared for Change of Name Hearing. Witnesses sworn and evidence presented. Comes now the
Court, having reviewed the Verified Petition for Change of Name, Notice of Proof of Publication, and
the evidence presented at the hearing, and now finds as follows:
1.
That Petitioner’s current name is: _________________________________________.
2.
That Petitioner’s date of birth is: ______________________________.
3.
That Petitioner’s Indiana driver’s license number/ Indiana identification card number was
filed with the Court and is preserved in the Court’s records.
That Petitioner’s mailing address is:
________________________________________________
________________________________________________
And, if different, Petitioner’s residence address is:
________________________________________________
_______________________________________________.
4.
5.
That Petitioner’s has no other previous names or Petitioner’s previous names are as
follows ___________________________________________________________________________.
6.
That Petitioner does/does not hold a valid United States passport.
7.
The Petitioner has presented proof of United States citizenship.
8.
That the Petitioner has no felony convictions, or, the following judgments of criminal
conviction of a felony under the laws of any state or the United States have been entered against the
Petitioner: ___________________________________________________________________.
9.
I.C. 11-8-8.
10.
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That Petitioner is not a sex or violent offender who is required to register under
That Petitioner has presented proof of publication of notice to the Court.
Form PS-34282-4
Approved by State Court Administration 10/10
American LegalNet, Inc.
www.FormsWorkFlow.com
11.
That pursuant to Indiana Code 34-38-2-1, Petitioner wishes to change his/her name.
12.
That Petitioner wishes to change his/her name to be
_____________________________________________________.
13.
That Petitioner is not seeking to defraud creditors by changing his/her name.
WHEREFORE IT IS ORDERED that Petitioner’s Petition for Change of Name is GRANTED,
and Petitioner’s name is hereby legally changed to __________________________________________.
SO ORDERED this _______ day of _____________________, 20____.
____________________________________
JUDGE
Distribution:
Page 2 of 2
Form PS-34282-4
Approved by State Court Administration 02/10
American LegalNet, Inc.
www.FormsWorkFlow.com
