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STATE OF INDIANA ) IN THE __________________ _______________ COURT )SS: COUNTY OF _________________ ) CAUSE NO. ____________________________________ IN RE THE NAME CHANGE OF ) MINOR: ) ) _____________________________ ) Name of Minor ) ) ) ) _____________________________ ) Petitioner ) APPEARANCE BY UNREPRESENTED 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) ☐ Responding (answering or defending) ☐ Intervening in this case I am not represented by a lawyer. 2. Contact information for receiving legal service of document and case information as required by Court 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 your location.) Address: Email address: ☐ I will accept service at the above email address. Phone: Fax: OR, if in a related case, you have used the Attorney General confidential address, you may check the box below: ☐ Attorney General confidential address Page 1 of 2 Approved by the Coalition for Court Access CCA-G F-0518-3010 3. This is a_________ case type as defined in Administrative Rule 8(B)(3). ( The Clerk will tell you the case type if you do not know it, so you may handwrite your response at the Clerk’s Office. ) 4.There ar e related cases: (If yes, please indi cate below) ☐ Yes ☐ No Capti on and case number of related cases: Caption: Case No.: Caption: Case No.: Caption: Case No.: Caption: Case No.: Caption: Case No.: Caption: Case No.: Addit ional information as required by local rule: Signature Page 2 of 2 Approved by the Coalition for Court Access CCA -GF -0518-3010 STATE OF INDIANA ) IN THE __________________ __ _____________ COURT )SS: COUNTY OF _________________ ) CAUSE NO. ____________________________________ IN RE THE NAME CHANGE OF ) MINOR: ) ) _____________________________ ) Name of Minor ) ) ) ) _____________________________ ) Petitioner ) VERIFIED PETITION FOR CHANGE OF NAME Petitioner, ________________________________________, pro se, respectfully petitions the court to change the name of the above-noted child. In support of this Petition, Petitioner states as follows: 1.P etitioner is the of the child whose name is sought to be changed. 2.That child’s current name is . 3.Th at the child’s date of birth is . 4.Th at the child’s mailing address is: ________________________________________________________________________\ ______ And if different, the child’s residential address is: ________________________________________________________________________\ _____ 5.That the child’s Indiana driver’s license number/Indiana identification card number is ______________________________________; and I will bring the child’s Indiana driver’s license or identification card to my Change of Name Hearing for verification. 6.The following is a list of all of the previous names of the child: ________________________________________________________________________\ ______ ________________________________________________________________________\ ______ 7.That the child ________ hold a valid United States passport. Proof that the child is a United States citizen is _______________________________. I will bring this document to the Change of N ame Hearing for verification. Page 1 of 2 Approved by the Coalition for Court Access CCA-MI-0219-2001 8.That t he following judgements of criminal conviction of a felony under the law of any state or the United States have been entered against the child, or I have stated immediately below that the child does not have any felony convictions: ________________________________________________________________________\ ______ ________________________________________________________________________\ ______ 9.That changing the child’s name is not an effort to defraud any of the child’s creditors. 10.That notice of the request for name change has been published in a local publication as required by law and will be brought to the Change of Name Hearing. 11.That the child is not confined to a Department of Correction facility or a sex or violent offender who is required to register under Indiana Code 11-8-8. 12.That pursuant to Indiana Code 34-28-2- 1, I petition this court to change the child’s name. Pursuant to Indiana Code 34-28-2-2(b), the reason the change of the child’s name is requested is: 13.That I request that the child’s name be changed to: 14. That I request that ( select one of the following): ☐ The name on the child’s birth certificate not be changed. ☐ The name on the child’s birth certificate be changed to new, changed n ame. Specifically, ___________________________________. 1 5. The parents or guardian of th e child have been served with a copy of this p etition as required by the Indian a trial rules. WHEREFORE, I respectfully request that this Cour t set this matter f or hearing, gr ant this Petition for Name Change of a Minor, and for all other just and proper relief. I affirm under penalties for perjury that the foregoing representations are true. ____________________________________ Signature ____________________________________ ____________________________________ ____________________________________ Pag e 2 of 2 Approved by the Coalition for Court Access CCA-MI-0219-2001 STATE OF INDIANA ) IN THE __________________ _______________ COURT )SS: COUNTY OF _________________ ) CAUSE NO. ____________________________________ IN RE THE NAME CHANGE OF ) MINOR: ) ) _____________________________ ) Name of Minor ) ) ) ) _____________________________ ) Petitioner ) AFFIDAVIT OF DILIGENT SEARCH Petitioner, _________________________________________, being duly sworn upon _________ oath, deposes and states: 1. I am the Petitioner in the above-entitled action and have personal knowledge of the matters stated herein. 2. I am the ____________ of the Minor Child. 3.I a m requesting to change the name of the Minor Child from __________________________________ to _____________________________________. 4. The non-petitioning parent’s name is ___________________________________. 5. I am unaware of the whereabouts of the non-petitioning parent. 6. I have done a diligent search and cannot find the whereabouts of the non- petitioning parent. W HEREFORE, I affirm under the penalties of perjury that the foregoing representations are true. ___________________________________ ________________________ ____________ Date Signature ____________________________________ ____________________________________ ____________________________________ ____________________________________ P age 1 of 1 Approved by the Coalition for Court Access CCA -MI -0219-2006 STATE OF INDIANA ) IN THE __________________ _______________ COURT )SS: COUNTY OF _________________ ) CAUSE NO. ____________________________________ IN RE THE NAME CHANGE OF ) MINOR: ) ) _____________________________ ) Name of Minor ) ) ) ) _____________________________ ) Petitioner ) NOTICE OF FILING PROOF OF PUBLICATION Petitioner, _______________________________________, pro se, states as follows: 1. I have given notice of the Petition for Change of Name of Minor Child, pursuant to Indiana Code 34-28-2-3. 2. Notice was given by three (3) weekly publications in a newspaper of general circulation published: ☐ in the county in which the petition is filed in court ☐ in the nearest adjacent county because no newspaper is published in the county in which the petition is filed 3. The first notice was published not more than seven (7) days after the date the Petition to Change Name of Minor Child was filed. 4. The published notice included: A. The name of the petitioner. B. The name of the minor child whose name is to be changed. C. The new name desired. D. The name of the court in which the action is pending and cause number. E. The date on which the petition was filed. F. The date, time, and location of the hearing. Page 1 of 2 Approved by the Coalition for Court Access CCA-MI -0219-2003 G. A statement that any person has the right to appear at the hearing and to file objections. 5. I have attached a copy of the published notice herein as Exhibit A. 6. The attached notice has been verified by the affidavit of a disinterested person. 7. More than thirty (30) days have passed since the final required publication of notice. WHEREFORE, I affirm under the penalties of perjury that the foregoing representations are true to the best of my knowledge and belief. ____________________________________ Signature Page 2 of 2 Approved by the Coalition for Court Access CCA-MI -0219-2003 STATE OF INDIANA ) IN THE __________________ _______________ COURT )SS: COUNTY OF _________________ ) CAUSE NO. ____________________________________ IN RE THE NAME CHANGE OF ) MINOR: ) ) _____________________________ ) Name of Minor ) ) ) ) _____________________________ ) Petitioner ) ORDER SETTING HEARING Notice is hereby given that Petitioner ________________________________________, pro se, filed a Verified Petition for Change of Name of Minor to change the name of minor child from ________________________________________________________________________\ to ________________________________________________________________________\ ___. The petition is scheduled for hearing in this Court on ________________________________________________________________________\ _____, which is more than thirty (30) days after the third notice of publication. Any person has the right to appear at the hearing and to file written objections on or before the hearing dat e. The parties shall report to _________________________________________________________________. Date: ________________________ ______________________________ Judicial Officer Distribution: _____________________________ _____________________________ _____________________________ _____________________________ _____________________________ Page 1 of 1 Approved by the Coalition for Court Access CCA-MI -0219-2004 STATE OF INDIANA ) IN THE __________________ _______________ COURT )SS: COUNTY OF _________________ ) CAUSE NO. ____________________________________ IN RE THE NAME CHANGE OF ) MINOR: ) ) _____________________________ ) Name of Minor ) ) ) ) _____________________________ ) Petitioner ) ORDER ON VERIFIED PETITION FOR CHANGE OF NAME OF MINOR C omes now the Court, having reviewed the Verified Petition for Change of Name of M inor and the Notice of Filing Proof of Publication, now finds as follows: 1. The Minor Child’s current name is 2. The Minor Child resides at : ________________________________________________________________________\ ______ 3. The Minor Child’s date of birth is : ____________________________________. 4. If the Minor Child has a felony conviction within the last ten (10) years, the required notice to the appropriate agencies has been provided. 5. The Petitioner wishes to change the Minor Child’s name to: ________________________________________________________________________\ ______ 6.The Petitioner: ☐ wishes to change the Minor Child’s name on Minor Child’s birth certificate, ☐ does not wish to change Minor Child’s name on Minor Child’s birth certificate 7.Th is Order is in accordance with the best interest of the Minor Child as guided by Indiana Code 31-17-2-8. Page 1 of 2 Approved by the Coalition for Court Access CCA-MI -0219-2005 and the name on the birth certificate of _______________________________________ shall be changed to ___________________________________________________. WHEREFORE, IT IS ORDERED that Petitioner’s Petition for Change of Name of Minor is GRANTED, and Minor’s name is hereby changed to: ________________________________________________________________________\ ____ The name on Minor’s birth certificate: ☐ should be changed to _______________________________________________. ☐ should not be changed. SO ORDERED ________________________________________________________________ Date: _________________________ ______________________________ Judicial Officer Distribution: _____________________________ _____________________________ Page 2 of 2 Approved by the Coalition for Court Access CCA-MI -0219-2005