VERIFIED PETITION FOR CHANGE OF NAME CASE NO. 20D03-1806-MI-247 IN THE ELKHART CIRCUIT COURT FOR THE STATE OF INDIANA, COUNTY OF ELKHART, SS: IN RE THE NAME CHANGE OF: Melissa Pauline Kaluzny; Petitioner Petitioner, Melissa Pauline Kaluzny, pro se, respectfully petitions this Court to change her name. In support of this Petition, Petitioner states as follows: That my current name is: Melissa Pauline Kaluzny. That my date of birth is: February 1, 1968. That I will bring my Indiana driver's license or identification card to my Change of Name Hearing for verification. That my mailing address is: 156 Tulip Blvd., Goshen, IN 46526. The following is a list of all of my previous names: Melissa Pauline McCleary. That I do hold a valid United States passport. I will bring this document to my Change of Name Hearing for verification. 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: N/A. That I am not seeking to defraud creditors by changing my name. 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. That I am not a sex or violent offender who is required to register under I.C. 11-8-8. That pursuant to Indiana Code 34-28-2-1, I wish to change my name. That I wish to change my name to: Melissa DeLaurenti. 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. Melissa Pauline Kaluzny 156 Tulip Blvd Goshen, IN 46526 June 11, 18, 25 hspaxlp
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