VERIFIED PETITION FOR CHANGE OF NAME STATE OF INDIANA SS COUNTY OF KOSCIUSKO IN RE THE NAME CHANGE OF Lindsey Renee Hurt, Petitioner IN THE KOSCIUSKO CIRCUIT COURT CASE NO. 43C01-1111-MI-95 Petitioner, Lindsey Renee Hurt, pro se, respectfully petitions this court to change his/her name. In support of this Petition, Petitioner states as follows: 1. That my current name is: Lindsey Renee Hurt 2. That my ate of birth is: August 4, 1981 3. That my Indiana driver's license number/Indiana identification card number is 1480-33-5330; and 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: 607 S. Columbia Street, Warsaw, IN 46580 5. The following is a list of all of my previous names: Lindsey Renee Hurt. 6. That I do not hold a valid United States passport. My proof that I am a United States citizen is Certified Birth Certificate. 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. 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 is want to change my name is: Gender Transition 12. That I wish to change my name to Alex Matthew Hurt 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. Lindsey Renee Hurt 607 S. Columbia Street Warsaw, IN 46580 n8,15,22
