VERIIFED PETITION FOR CHANGE OF NAME CASE NO. 20C01-1606-MI-169 IN THE ELKHART CIRCUIT COURT COURT FOR THE STATE OF INDIANA, COUNTY OF ELKHART, SS: IN RE THE NAME CHANGE OF: Rebecca Elaine VanElk, Petitioner. Petitioner, Rebecca Elaine VanElk, pro se, respectfully petitions this court to change her name. In support of this Petition, Petitioner states as follows: 1.That my current name is: Rebecca Elaine VanElk. 2.That my date of birth is: August 13, 1980. 3.That I will bring my Indiana driver's license or identification card to my Change of Name Hearing for verification. 4.That my mailing address is: 61022 Waterwood Ln, Goshen, IN 46528. 5.The following is a list of all of my previous names: Rebecca Elain VanElk, Rebecca Elaine Van Elk. 6.That I do hold a valid Untied States passport. My proof that I am a United States citizen is a passport. I will bring this document to my Change of Name Hearing for verification. 7.That the following judgments of criminal conviction of a felony under the laws of any state or the United States have been entered against me, or I have stated immediately below that I have no felony convictions: I have no felony convictions. 8.That I am not seeking to defraud creditors by changing my name. 9.That I have published notice of my request for name change in a local publication as required by law, and will bring proof of publication to the hearing. 10.That I am not a sex or violent offender who is required to register under I.C. 11-8-8. 11.That pursuant to Indiana Code 34-28-2-1, I wish to change my name. The reason I want to change my name is: marriage. 12.That I wish to change my name to: Rebecca Elaine Gardner. WHEREFORE, I respectfully request that this Court grant my Petition for Name Change, and for all other just and proper relief. I affirm under the penalties of perjury that the foregoing representations are true. Rebecca Elaine VanElk 61022 Waterwood Ln. Goshen, IN 46528 June 11, 18, 25 hspaxlp
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