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Fill and Sign the Name Change for Minor with Consent Clark County Indiana Form

Fill and Sign the Name Change for Minor with Consent Clark County Indiana Form

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Page 1 of 1 Form PS -34282 -10 Approved by State Court Administration 12/10 STATE OF INDIANA ) IN THE CIRCUIT COURT ) SS: COUNTY OF ) CASE NO. IN RE CHANGE OF ) NAME OF MINOR: ) ) ) ) Petitio ner. ) ORDER ON VERIFIED PETITION FOR CHANGE OF NAME OF MINOR Comes now the Court, having reviewed the Verified Petition for Change of Name of Minor and the Notice of Filing Proof of Publication, and having confirmed service on the non -petitioning pare nt 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. The Minor Child has not been convicted of a felony within the last ten (10) years. 5. The Petitioner wishes to change the Minor Child’s name to: . 6. This Order is in accordance with the best interest of the Minor Child as guided by IC 31 -17 -2-8. WHEREFORE, IT IS ORDERED that Petitioner’s Petition for Change of Name of Minor is GRANTED , and Minor’s name is hereby changed to . Date Judge ____________ Circuit Court Distribution: Print Your Name Mailing Address Town, State and Zip Code Telephone Number, with Area Code

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