Indiana state law requires that you post a notice of your name change petition in a local newspaper. Once this is done, you should provide the newspaper with an Affidavit of Publication of Notice of Name Change Petition to verify that the publication was completed.

Use this form to:

• Verify that you have publicly disclosed that you are changing your name.
• Detail where and on what dates the publication was made.
• Comply with Indiana state disclosure requirements.

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