Verified Petition For Change Of Name Form. This is a Indiana form and can be use in Family Law (Pro-Se) Statewide.
Tags: 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. ) 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 my date of birth is: _______________________________. 3. That my Indiana driver’s license number/Indiana identification card number is ______________________________; and I will bring my Indiana driver’s license or identification card to my Change of Name Hearing for verification. 4. That my mailing address is: ________________________________________________ ________________________________________________ And, if different, my residence address is: ________________________________________________ ________________________________________________. 5. The following is a list of all of my previous names: __________________________________________________________________________________. 6. That I ________ hold a valid United States passport. My proof that I am a United States citizen is __________________________. I will bring this document to my Change of Name Hearing for verification. 7. That the following judgments of criminal conviction of a felony under the laws of any state or the United States have been entered against me, or I have stated immediately below that I have no felony convictions: __________________________________________________________________________________. 8. That I am not seeking to defraud creditors by changing my name. 9. That I have published notice of my request for name change in a local publication as required by law, and will bring proof of publication to the hearing. 10. Page 1 of 2 That I am not a sex or violent offender who is required to register under I.C. 11-8-8. Form PS-34282-1 Revised by State Court Administration 10/10 American LegalNet, Inc. www.FormsWorkFlow.com 11. That pursuant to Indiana Code 34-38-2-1, I wish to change my name. The reason I want to change my name is: __________________________________________________________________________________. 12. 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 Page 2 of 2 Form PS-34282-1 Revised by State Court Administration 10/10 American LegalNet, Inc. www.FormsWorkFlow.com