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Fill and Sign the Affidavit of Publication for Name Change Indiana 497307101 Form

Fill and Sign the Affidavit of Publication for Name Change Indiana 497307101 Form

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STATE OF INDIANA COUNTY OF ________________________ AFFIDAVIT PERSONALLY APPEARED BEFORE ME, in the county aforesaid, ____________________________________ , who after being duly sworn, does state on his/her oath that the attached newspaper clipping represents publication in a newspaper three (3) times in the County the Petitioner resides or the nearest county or a newspaper of general circulation with regard to the Petition of ____________________________________ . THIS, the ______ day of ________________________ , 20 ______ . ___________________________________ DISINTERESTED PARTY SUBSCRIBED AND SWORN TO BEFORE ME, this the ______ day of ________________________ , 20 ______ . ___________________________________ NOTARY PUBLIC My Commission Expires: ________________________

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