Fill and Sign the Affidavit of Publication for Name Change Indiana Form

STATE OF INDIANA ) IN THE ____________ CIRCUIT COURT ) SS: COUNTY OF       ) CASE NO.       ) IN RE THE NAME CHANGE OF: ) )       ) Petitioner. AFFIDAVIT OF PUBLICATION I hereby certify that the Notice of Suit entitled “Petition for Change of Name,” was published three (3) times, as prescribed by law, in the       , a newspaper in the City of       , County of       , Indiana, on the following dates: 1.       , 20       ; 2.       , 20       ; 3.       , 20       ; I further certify that copies of the three said Notices, designated as First, Second, and Third Notice of Suit, respectively, and the publisher’s affidavit regarding same, are hereto attached and made a part of this return. I further certify that the newspaper aforesaid met all legal requirements applicable to such publication. _____________________________ Signature Print your name Official Title Mailing Address Town, State and Zip Code Telephone number, with area code