Name Change Packet

Please answer the questions below. When you answer the questions, they will automatically fill in that information where it belongs on the following forms that you will be filing with the court. Do not leave any questions blank. Any changes you make must be made to these questions; you will not be able to modify your answers in the forms themselves. 1.What is the name of the County where you will be filing these forms? 2.What is your current full name? 3.What is the full name you would like to change your name to? 4.What is your mailing address? 5.What is the town, state, and ZIP Code for your mailing address? 6.If your street address where you live is a different address from your mailing address, what is yourstreet address? 7.What is the town, state, and ZIP Code for your street address? 8.What is your telephone number, with area code? 9.If you have a fax machine number and want to receive service by fax machine, what is your faxmachine number, with area code? 10.What is your date of birth? 11.What is your Indiana 12.Please list all of your previous names. American LegalNet, Inc. www.FormsWorkFlow.com 13. 14.If you do not have a valid passport, what document do you have as proof that you are a U. S. citizen? (Certified birth certificate, Consular report of birth abroad or certification of birth, naturalization certificate, certificate of citizenship, or secondary documents. For a list of secondary documents, please visit 15.List the judgments of felony convictions under the laws of any state or the United States that havebeen entered against you. If you have had a felony conviction within ten (10) years, you must provide notice of the filing of this Petition for Name Change to: (1) the sheriff of the county in which you reside; (2) the prosecuting attorney of the county in which you reside; and (3) the Indiana central repository for criminal history information. The notice given to the Indiana central repository for criminal history information must include your full current name, requested name change, date of birth, address, physical description, and a full set of classifiable fingerprints. Failure to provide notice at least 30 days prior to the hearing on this Petition is a Class A Misdemeanor. 16.Why do you want to change your name? You have finished answering the questions. The following pages are the forms that you will be printing and then filing with the court. Please look over them to make sure the information is correct before you print them out. If you have changes, you must make them to the questions above. You may also save a copy of this packet if you need to obtain more information before answering the questions. PLEASE NOTE: The court will set a hearing date when you file your Petition. Make sure this date is filled in on the Notice of Petition for Change of Name. You will need to take this Notice to the person who handles legal notices in your local newspaper. This Notice must appear once a week for three weeks. The last publication must be at least 30 days before the hearing. The newspaper will then send a proof of publication notice to you, which you will attach to the Notice of Filing Proof of Publication and then file these forms with the court. American LegalNet, Inc. www.FormsWorkFlow.com Page 1 of 2 Form TCM-TR3.1-2 Revised by State Court Administration 10/10 STATE OF INDIANA ) IN THE CIRCUIT COURT ) SS: COUNTY OF ) CASE NO. IN RE THE NAME CHANGE OF: ) ) ) ) Petitioner. ) APPEARANCE BY SELF-REPRESENTED PERSON IN CIVIL CASE This Appearance Form must be filed on behalf of every party in a civil case. 1.My Name is: and I am Initiating (filing) X ; Responding (answering or defending); or Intervening ; in this case and am representing myself. 2.Contact information for receiving legal service of documents and case information is required byCourt Rules: (NOTE: If you are the Initiating party and this case, or a related case, involves a protection from abuse order, a workplace violence restraining order, or a no-contact order, you must provide an address for the purpose of legal service of documents but that address should not be one that exposes the whereabouts of a petitioner) Address: Email Address: Phone: FAX: OR, if in the related case, you have used the Attorney General Confidential address, you may check the box below: Attorney General confidential address (contact the Attorney General at 1-800-321-1907 or e-mail address is confidential@atg.state.in.us). 3.This is a case type as defined in administrative Rule 8(B)(3).(Clerk will supply this information.) 4.I will accept service by FAX at the following number American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 2 Form TCM-TR3.1-2 Revised by State Court Administration 10/10 5.This case is a domestic relations matter, involves reciprocal enforcement of child support,paternity, delinquency, Child in Need of Services (CHINS), guardianship, or any other proceedings in which support may be an issue, and social security numbers of all family members are supplied on a separately attached document (Form TCM-TR3.1-4) filed as confidential information on light green paper. Yes X No 6.There are related cases: Yes No X (If yes, please indicate below.) Caption and case number of related cases: Caption: Case Number: Caption: Case Number: Caption: Case Number: Caption: Case Number: Caption: Case Number: Caption: Case Number: 7.Additional information required by local rule: Self-Represented Party American LegalNet, Inc. www.FormsWorkFlow.com Page 1 of 2 Form PS-34282-1 Revised by State Court Administration 10/10 STATE OF INDIANA ) IN THE 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 my date of birth is: . 3.That my IIndiana identification card number isto 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 Statescitizen 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 anystate 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 asrequired by law, and will bring proof of publication to the hearing. 10.That I am not a sex or violent offender who is required to register under I.C. 11-8-8. American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 2 Form PS-34282-1 Revised by State Court Administration 10/10 11.That pursuant to Indiana Code 34-28-2-1, I wish to change my name. The reason I wantto 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 American LegalNet, Inc. www.FormsWorkFlow.com Page 1 of 1 Form PS-34282-2 Revised by State Court Administration 10/10 STATE OF INDIANA ) IN THE CIRCUIT COURT ) SS: COUNTY OF ) CASE NO. IN RE THE NAME CHANGE OF: ) ) ) ) Petitioner. ) NOTICE OF FILING PROOF OF PUBLICATION Petitioner, , pro se, states as follows: 1.I have given notice of my Petition for Change of Name, pursuant to Indiana Code 34-28-2-3(a). 2.I have attached a copy of the published notice herein as Exhibit A. 3.The attached notice has been verified by the affidavit of a disinterested person. 4.More than thirty (30) days have passed since the last required publication of notice. WHEREFORE, I respectfully request that this Court consider my Petition for Name Change, and for all other just and proper relief. I affirm under the penalties of perjury that the foregoing r