Fill and Sign the In Name Change Indiana 497307088 Form

STATE OF INDIANA ) IN THE       CIRCUIT COURT ) SS: COUNTY OF       ) CASE NO.       IN RE THE NAME CHANGE OF: ) ) )       ) Petitioner. ) ORDER ON VERIFIED PETITION FOR CHANGE OF NAME On       , Petitioner       , appeared for Change of Name Hearing. Witnesses sworn and evidence presented. Comes now the Court, have reviewed the Verified Petition for Change of Name, Notice of Proof of Publication, and the evidence presented at the hearing, and now finds as follows: 1. That Petitioner's current name is:       . 2. That Petitioner's date of birth is:       . 3. That Petitioner's Indiana driver's license number/Indiana identification card number was file with the Court and is preserved in the courts records. 4. That Petitioner's mailing address is:             And, if different, Petitioner's residence address is:             5. That Petitioner's has no other previous names or petitioner's previous names are as follows:       . 6. Petitioner does/does not hold a valid United States passport. 7. The Petitioner has presented proof of United States Citizenship. 8. That the petitioner has no felony convictions, or, the following judgments of criminal conviction of a felony under the laws of any state or United States have been entered against the Petitioner:       . 9. That Petitioner is not a sex or violent offender who is required to register under Page 1 of 2 Form PS-34282-4 Revised by State Court Administration 10/10 I. C. 11-8-8. 10. That Petitioner has presented proof of publication of notice to the Court. 11. That pursuant to Indiana Code 34-28-2-1, Petitioner wishes to change his/her name. 12. That Petitioner wishes his/her name to be       . 13. That Petitioner is not seeking to defraud creditors by changing his/her name. WHEREFORE IT IS ORDERED that Petitioner’s Petition for Change of Name is GRANTED, and Petitioner’s name is legally changed to       . SO ORDERED this       day of       , 20       . JUDGE Distribution:                   Page 2 of 2 Form PS-34282-4 Revised by State Court Administration 10/10