ORDER ON VERIFIED PETITION FOR CHANGE OF NAME STATE OF INDIANA SS COUNTY OF KOSCIUSKO IN RE THE NAME CHANGE OF DUSTIN WILLIAM PARKER, Petitioner IN THE KOSCIUSKO CIRCUIT COURT CASE NO. 43C01-1304-MI-49 On______, Petitioner, Dustin William Parker appeared for Change of Name Hearing. Witnesses sworn and evidence presented. Comes now the Court, having reviewed the Verified Petition for Change of Name, Notice of Proof of Publication, and the evidence presented at the hearing, and now finds as follows: 1. That Petitioner's current name is: Dustin William Parker 2. That Petitioner's date of birth is: June 29, 1995 3. That Petitioner's Indiana Drivers license number/Indiana identification card number was filed with the Court and is preserved in the Court's records. 4. That Petitioner's mailing address is: 208 Stone Wall Ct. Apt 4, Nappanee, IN 46550. and, if different, Petitioner's residence address is: ___NA____ 5. That Petitioner's has no other previous names or Petitioner's previous names are as follows ___NA____ 6. That Petitioner does/does not hold a valid United States passport. 7. That Petitioner has presented proof of United States citizenship. 8. That the Petitioner has no felony convictions, or, the following judgments of criminal conviction of a felony under the laws of nay state or the United States have been entered against the Petitioner:_____. 9. That Petitioner is not a sex or violent offender who is required to register under I.C. 11-8-8. 10. That Petitioner has presented proof of publication of notice to the Court. 11. That pursuant to Indiana Code 34-28-2-1, Petitioner wishes to change his/her name. 12. That Petitioner wishes to change his/her name to be Dustin William Buie. 12. That Petitioner is not seeking to defraud creditors by changing his/her name. Wherefore it is ordered that Petitioner's Petition for Change of Name is Granted, and Petitioner's name is hereby legally changed to Dustin William Buie. So ordered this_____day of_______,20____ _________Judge Distribution Dustin William Parker 208 Stone Wall Ct Apt 4 Nappanee, IN 46550 10-10,17,24 hspaxlp
