VERIFIED PETITION FOR CHANGE OF NAME CAUSE NO. 20C01-1908-MI-329 IN THE ELKHART CIRCUIT COURT FOR THE STATE OF INDIANA, COUNTY OF ELKHART, SS: IN RE THE NAME CHANGE OF: Johannes Franciscus Landa, PETITIONER Petitioner, Johannes Franciscus Landa, pro se, respectfully petitions the Court to change his name. In support of this Petition, Petitioner states as follows: 1.That my current name is Johannes Franciscus Landa. 2.That my date of birth is 07-15-1950. 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 71701 County Road 133, Syracuse, IN 46567. 5.The following is a list of all of my previous names: John Franciscus Landa. 6.That I do hold a valid United States passport. My proof that I am a United States citizen is Certificate #A462277. 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 law of any state or the United States have been entered against me, or I have stated immediately below that I have no felony convictions: None 8.That I am not seeking to defraud creditors by changing my name. 9.That I have published notice of my request for Change of Name 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 Indiana Code 11-8-8. 11.That I wish to change my name to John Franciscus Landa. 12.That I request that the name on my birth certificate not be changed. WHEREFORE, I respectfully request that this Court grant my Petition for Name Change, and for all other just and proper relief. I affirm under penalties for perjury that the foregoing representations are true. Johnannes Landa 71701 County Road 133 Syracuse, IN 46567 August 22, 29 September 5 hspaxlp
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