STATE OF INDIANA                       )           IN THE __________________________COURT

                                                            ) SS:   

COUNTY OF _________________  )           CASE NO. ______________________________    

 

 

IN RE THE NAME CHANGE OF:  )

                                                            )

___________________________      )

Petitioner.                                )

 

APPEARANCE

 

1.         Petitioner:                    ___________________________________

2.         Attorney Information:            Self-Represented

3.         Case Type : MI          

4.         Will NOT accept FAX service.

5.         Are there related cases? Yes___ No ___ 

            Case Number(s): __________________________________________________

                                                                                    _____________________________             

Signature

_____________________________

Print your name

                                                                                    _____________________________

                                                                                    Mailing Address

                                                                                    _____________________________

                                                                                    Town, State and Zip Code

                                                                                    _____________________________

                                                                                    Telephone number, with area code