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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.
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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