Page 1 of 2 Form TCM-TR3.1-2
Revised by State Court Administration 10/10
STATE OF INDIANA ) IN THE _______________ CIRCUIT COURT
) SS:
COUNTY OF _______________ ) CASE NO. ______________________________
IN RE THE NAME CHANGE OF: )
)
)
)
Petitioner. )
APPEARANCE BY SELF-REPRESENTED PERSON IN CIVIL CASE
This Appearance Form must be filed on behalf of every party in a civil case.
1. My Name is: ___________________________________ and I am
Initiating (filing) X ;
Responding (answering or defending)_____; or
Intervening ____;
in this case and am representing myself.
2. Contact information for receiving legal service of documents and case information is required by
Court Rules: (NOTE: If you are the Initiating party and this case, or a related case, involves a
protection from abuse order, a workplace violence restraining order, or a no-contact order, you must
provide an address for the purpose of legal service of documents but that address should not be one that
exposes the whereabouts of a petitioner)
Address: _____________________________________
_____________________________________________
Email Address: ________________________________
Phone: _______________________________________
FAX: ________________________________________
OR, if in the related case, you have used the Attorney General Confidential address, you may check the
box below:
____ Attorney General confidential address (contact the Attorney General at 1-800-321-1907 or
e-mail address is confidential@atg.state.in.us).
3. This is a __________ case type as defined in administrative Rule 8(B)(3).
(Clerk will supply this information.)
4. I will accept service by FAX at the following number _________________________
