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VERIFIED PETITION FOR CHANGE OF NAME STATE OF INDIANA SS COUNTY OF KOSCIUSKO IN RE THE NAME CHANGE OF KATHERINE PAULA GERVAIS IN THE KOSCIUSKO SUPERIOR/CIRCUIT COURT CAUSE NO. 43C01-0812-MI-636 Petitioner, Katherine Paula Gervais, 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: Katherine Paula Gervais. 2. That I reside at: 600 N. Colfax St., #207 Warsaw, IN 46580. 3. That pursuant to Code 34-28-2-1, I wish to change my name. 4. That I am not seeking to defraud creditors by changing my name. 5. That I have not been convicted of a felony within the last ten (10) years. 6. That I wish to change my name to: Paula B. Gervais. 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. Katherine Paula Gervais 600 N. Colfax St., #207 Warsaw, IN 46580 574-267-7172 d16,23,30
