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Page 1 of 1 CCA-MI-0820-2000E
www.indianalegalhelp.org
INSTRUCTIONS: CHILD GENDER MARKER CHANGE
☐Fill out the forms. There are two ways you can complete these forms:
(a) You can use a computer to fill in the form blanks. After you fill in the blanks
you must print out the forms; or
(b) You can print out the forms and handwrite your answers.
☐Read your local court rules to find out how many copies you will need, and if there
are any additional forms or procedures required in your county.
☐Sign your forms and make copies.
☐Take the originals and copies of your forms to the Clerk of the Court in your
county. The Clerk will provide the case number and process the forms. The Clerk will
stamp the forms with a filing date and give you back a copy.
☐The court will set a hearing date when you file your Petition.
☐Attend the hearing. If you feel unsafe having a public hearing, see more instructions
beginning on the eighth page of this packet.
☐Scroll down for instructions on how to complete these forms.
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STATE OF INDIANA ) IN THE __________________ _______________ COURT
)SS:
COUNTY OF _________________ ) CAUSE NO. ____________________________________
IN RE THE GENDER CHANGE )
OF MINOR: )
)
_____________________________ )
Name of Minor )
)
)
)
_____________________________ )
Petitioner )
APPEARANCE BY UNREPRESENTED PERSON IN CIVIL CASE
1. My name is _________________________________ and I am the Petitioner, the initiating
party.
2. In this case I am not represented by a lawyer.
3. Contact information for receiving legal service of document and case information as required
by Court Rules. (If 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
your location.)
Address:
Email address:
☐ I will accept service at the above email address.
Phone:
Fax:
OR, if in a related case, you have used the Attorney General confidential address, you may
check the box below:
☐ Attorney General confidential address
3. This is an MI case type as defined in Administrative Rule 8(B)(3).
____
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4. There are related cases: (If yes, please indicate below)
☐ Yes
☐ No
Caption and case number of related cases:
Caption: Case No.:
Caption: Case No.:
Caption: Case No.:
Additional information as required by local rule:
I am the only party to this proceeding and therefore there is no other party to serve.
Signature
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STATE OF INDIANA ) IN THE __________________ _______________ COURT
)
COUNTY OF _________________ ) CAUSE NO. ____________________________________
IN RE THE GENDER CHANGE )
OF MINOR: )
)
_____________________________ )
Name of Minor )
)
)
)
_____________________________ )
Petitioner )
VERIFIED PETITION FOR CHANGE OF GENDER OF MINOR
Petitioner, ________________________________________, pro se, respectfully
petitions the court to change the gender of the above-noted child pursuant to the inherent equity
jurisdiction of the court. In support of this Petition, Petitioner states as follows:
1. Petitioner is the of the child whose gender is sought to be changed.
2. The child’s current legal name is _________________________________________.
3. The current sex designation on the child’s birth certificate is ___________.
4. The child’s date of birth is ____________________.
5. That the child’s mailing address is:
______________________________________________________________________________
And if different, the child’s residential address is:
______________________________________________________________________________
6. ☐ Child has not been known by any other legal names.
☐ Previously child’s legal name was: ________________________________________.
7. The child was born in ________________________ and is a United States citizen.
8. This petition is made in good faith and not for fraudulent purposes.
9. Pursuant to the inherent equity jurisdiction of the court and In Re Petition for Change of
Birth Certificate, 22 N.E.3d 707 (Ind. Ct. App. 2014), I want to change child’s gender marker
from ____________ to _____________.
10. I want to make this change because:
____
__
____
____
____
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☐I want the child’s legal gender to accurately reflect the child’s gender identity
and presentation.
☐Other:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
WHEREFORE the undersigned prays that the Court set this matter for hearing, that the
Court grant this Verified Petition for Change of Gender of Minor, and for all other just and
proper relief.
I am the only party to this case, therefore there is no other party to serve.
I affirm under penalties for perjury that the foregoing representations are true to
the best of my knowledge and belief.
________________________________ __________________________________________
Date Signature
__________________________________________
Printed Legal Name
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STATE OF INDIANA ) IN THE __________________ _______________ COURT
)
COUNTY OF _________________ ) CAUSE NO. ____________________________________
IN RE THE GENDER CHANGE )
OF MINOR: )
)
_____________________________ )
Name of Minor )
)
)
)
_____________________________ )
Petitioner )
ORDER SETTING HEARING
Comes now _____________________________________, pro se, having filed a Verified
Petition for Change of Gender of Child, and the Court finds that the matter should be set for hearing.
IT IS THEREFORE ORDERED that this matter shall be heard on
__________________________________________________________________________________.
So ORDERED ____________________________________________________________________
_______________________________________
Judicial Officer
Distribution:
___________________________________________
___________________________________________
___________________________________________
____
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STATE OF INDIANA ) IN THE __________________ _______________ COURT
):
COUNTY OF _________________ ) CAUSE NO. ____________________________________
IN RE THE GENDER CHANGE )
OF MINOR: )
)
_____________________________ )
Name of Minor )
)
_____________________________ )
Petitioner )
ORDER ON VERIFIED PETITION FOR CHANGE OF GENDER OF MINOR
The Court, having reviewed the Verified Petition for Change of Gender Of Minor and the
evidence presented at the hearing now finds:
1. Petitioner is seeking to change their gender in good faith and not for a fraudulent
or unlawful purpose. In Re Petition for Change of Birth Certificate, 22 N.E.3d 707 (Ind. Ct.
App. 2014).
2. ☐ Minor Child, _________________________________ does not have a former
legal name.
☐ Minor Child, __________________________________ had a former legal
name, ____________________________________.
3. Minor Child’s ___________________________________ date of birth is
_______________________________.
IT IS THEREFORE ORDERED that Petitioner’s Verified Petition for Change of Gender Of
Minor is GRANTED.
Minor Child’s legal gender is changed from _______________ to _______________.
IT IS FURTHER ORDERED that all agencies and institutions issuing the Minor Child identity
documents are directed to amend such documents consistent with this order, including but not
limited to the Indiana State Department of Health and its subdivisions.
So ORDERED: ________________________________________________________________
____________________________________
Judicial Officer
Distribution:
___________________________________________
___________________________________________
___________________________________________
____
____
____
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You do not have to file the following documents, but you may want to. Read below and
then decide whether you want to fill out and file them.
Court rules allow you to ask that records be sealed (not available to the public) for your
safety. If you feel having this case public would put you at significant risk of substantial
harm, fill out all of the following forms and submit them to the Clerk of Court when
you start your gender change case.
1. The first document is Notice of Exclusion of Confidential Information
From Public Access. This lets the court know you want the court to keep the papers you
file out of public view.
2. The second document is the Verified Request to Prohibit Public Access
Pursuant to Indiana Rules on Access to Court Records. This is a request to the Judge to
make your case confidential. This is where you should detail all the reasons you would
feel unsafe having your gender change made public
3. The third document is the Memorandum of Law in Support of Verified
Request to Prohibit Public Access Pursuant to Rules on Access to Court Records.
Indiana Legal Services wrote this memo to explain to the Judge why, in general, it can
be unsafe for trans people to be outed, and why this means the gender change of a
transgender person should be sealed (confidential).
4. The fourth document is the Public Notice of Hearing. The law says that if
you ask a judge to make the case confidential, there must be a public hearing on the
sealing request (that’s the second document listed above). To let the public know about
the hearing, the court posts this notice in the courthouse at least 30 days before the
hearing.
5. Finally, the fifth document is the Order on Request to Prohibit Public
Access Pursuant to Indiana Rules on Access to Court Records. This is a document that
you want the Judge to sign. If the Judge decides that your case should remain
confidential, not viewable by the public, then the Judge will sign this document and
your case will be sealed.
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STATE OF INDIANA ) IN THE __________________ _______________ COURT
)
COUNTY OF _________________ ) CAUSE NO. ____________________________________
IN RE THE GENDER CHANGE )
OF MINOR: )
)
_____________________________ )
Name of Minor )
)
)
)
_____________________________ )
Petitioner )
NOTICE OF EXCLUSION OF CONFIDENTIAL INFORMATION FOR PUBLIC
ACCESS
Contemporaneous with the filing of their Verified Petition For Change Of Gender Of
Minor, __________________________________ and pursuant to Indiana Rules on Access to
Court Records, Petitioner provides this notice that the information listed below is to remain
excluded from public access in accordance with Rule 6:
1. Appearance
2. Verified Petition for Change of Gender of Minor
3. Order on Verified Petition for Change of Gender
4. Notice of Exclusion of Confidential Information for Public Access
5. Verified Request to Prohibit Public Access Pursuant to Indiana Rules on Access to Court
Records
6. Memorandum of Law in Support of Verified Request to Prohibit Public Access and/or
Waive Publication Pursuant to Rules on Access to Court Records
7. Order on Verified Request To Prohibit Public Access Pursuant to Indiana Rules on
Access to Court Records
I am the only party to this proceeding. Hence there is no other party to be served.
Respectfully submitted,
_____________________________________ __________________________________
Signature Date
_____________________________________
Printed Legal Name
____
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STATE OF INDIANA ) IN THE __________________ _______________ COURT
)
COUNTY OF _________________ ) CAUSE NO. ____________________________________
IN RE THE GENDER CHANGE )
OF MINOR: )
)
_____________________________ )
Name of Minor )
)
)
)
_____________________________ )
Petitioner )
VERIFIED REQUEST TO PROHIBIT PUBLIC ACCESS PURSUANT TO INDIANA
RULES ON ACCESS TO COURT RECORDS
I, ___________________________________________________, respectfully petition this
Court to seal the record of my child’s gender marker change proceeding, permanently prohibiting
Public Access to the entire court record pursuant to Indiana Rules on Access to Court Records. In
support of this request, I state:
1. I am: ☐transgender
☐gender non-conforming
☐nonbinary
☐_______________________
2. I am seeking to change my child’s gender to accurately reflect my gender identity and
presentation.
3. I am aware of the high rates of violence, discrimination, and invasion of privacy against
transgender, gender non-conforming and nonbinary people in Indiana and nationwide and I fear that
if the public knows my child’s gender identity, they will personally experience violence,
discrimination and an invasion of privacy.
4. I fear that if someone could find my child’s gender change request and address online,
that they could be targeted for discrimination and/or violence based on their gender identity.
5. I also fear for their safety because of personal experience with violence and
discrimination.
6. They have personally suffered ☐ physical harm ☐ discrimination ☐ harassment
☐ bullying ☐ threats of violence ☐ other:
____
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_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
7. I am attaching a Memorandum of Law in Support of Verified Request to Prohibit Public
Access And/Or Waive Publication Pursuant to Rules on Access to Court Records by Indiana Legal
Services as an Exhibit.
8. There are no other parties or interested persons to this action.
THEREFORE, I respectfully request that pursuant to Indiana Rules on Access to Courts,
this case be excluded from public access by sealing the record of this proceeding.
I affirm under penalties for perjury that the foregoing representations are true to the best of
my knowledge and belief.
Date Signature
Printed Legal Name
MEMORANDUM OF LAW IN SUPPORT OF
VERIFIED REQUEST TO PROHIBIT PUBLIC ACCESS AND/OR WAIVE
PUBLICATION PURSUANT TO RULES ON ACCESS TO COURT RECORDS
1. This memorandum of law was drafted by Indiana Legal Services’ LGBT Project to support self-
represented litigants who fear for their safety to a request pursuant to the Rules on Access to
Court Records
1
to waive publication and sale the records of their case.
2. Name change cases are subject to the public access rules containing in Indiana Rules of Court
Administration 9. Ind. Code § 34-28-2-2.5(b).
I. HAVING TO PUBLISH NOTICE IN A NEWSPAPER AND HAVING THEIR CASE
PUBLICLY AVAILABLE PUTS PETITIONER AT SUBSTANTIAL RISK OF HARM.
3. The Court of Appeals is clear that the evidence of heightened risk of harassment, violence, and
homicide to transgender individuals nationally and in Indiana is enough to demonstrate significant
risk of harm warranting prohibiting public access. In re Name Change of M.E.B., 19A-MI-118 at
¶ 11 (June 21, 2019).
4. The purpose of the Access to Court Records Rule is, among other things, to minimize an
individual’s risk of injury. The Commentary to the Rule recognizes “that unrestricted access to
certain information in Court Records could result in an unwarranted invasion of personal privacy
or unduly increase the risk of injury to individuals and businesses.” Ind. Access to Court Records
1, cmt. “. . . The goal of the Rules on Access to Court Records is proactive; it seeks to prevent
harm. To force petitioners to wait until they have already experienced that harm would vitiate the
purpose of the rule.” Id.; accord In Re K.H., 127 N.E.3d 257 (Ind. Ct. App. 2019)
5. A.C.R. Rule 6 requires Judges to look at the totality of the circumstances to evaluate if a substantial
risk of harm exists and to proactively protect applicants’ safety. Rule 6 does not require that
Plaintiff endure targeted threats, violence, or abuse before granting temporary and permanent
1
The Access to Court Records Rules replaced Administrative Rule 9 on January 1, 2020. Rules on Access to Court Records
moved portions of Administrative Rule 9 and placed them in a more organized manner. A.C.R. Rule 6 is Administrative Rule
9(G)(4) without change.
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sealing and a publication waiver. In Re M.E.B., 126 N.E.3d 932 at 934 (Ind. Ct. App. 2019); In Re
K.H., 127 N.E.3d 257 (Ind. Ct. App. 2019)
6. Part of the circumstances to consider is the reality that transgender people are disproportionately
impacted by violence and homicide. The United Sates is the third most deadly country for trans
people.
7. Between 2013 and 2015, hate crimes against transgender people increased 239 percent, with LGBT
people more likely than any other minority group to experience hate crimes in the United States.
Haeyoung Park and Iaryna Mykhyalyshyn, L.G.B.T. People Are More Likely to Be Targets of Hate
Crimes Than Any Other Minority Group, N.Y. TIMES, June 16, 2016.
8. The systemic violence transgender people experience neither begins nor ends with hate crimes,
physical assault or homicide. Transgender people are more likely than the general population to
experience discrimination, harassment, and violence in every facet of life, including family
relations, education, employment, housing, public accommodations, obtaining accurate
identification documents, and accessing adequate and appropriate medical treatment. . See e.g.
James et al., The Report of the 2015 U.S. Transgender Survey (2016), available at
http://www.ustranssurvey.org/reports/; National Coalition of Anti-Violence Programs, A Report
from the National Coalition of Anti-Violence Programs: Lesbian, Gay, Bisexual, Transgender,
Queer, and HIV-Affected Hate Violence in 2013 (2014), available at http://avp.org/wp-
content/uploads/2017/04/2013_ncavp_hvreport_final.pdf; Jaime M. Grant et al., Injustice at Every
Turn: A Report of the National Transgender Discrimination Survey 2 (2011), available at
http://www.thetaskforce.org/downloads/reports/reports/ntds_full.pdf.
9. This is no less true in the state of Indiana. A survey of transgender people in Indiana conducted in
conjunction with the National Transgender Discrimination Survey found that 73% of respondents
reported harassment in their K-12 school; and 27% reported physical assault. National Center for
Transgender Equality and the National Gay and Lesbian Task Force, Findings of the National
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Transgender Discrimination Survey: Indiana Results (2015), available at
http://www.transequality.org/sites/default/files/docs/usts/USTSINStateReport% 281017%29.pdf.
10. In another study of Transgender Hoosiers, 74% of respondents reported experiencing harassment
or mistreatment on the job. Christy Mallory and Brad Sears, Employment Discrimination Based
on Sexual Orientation and Gender Identity in Indiana, August 2017, available at
https://williamsinstitute.law.ucla.edu/research/in_discrimination_ aug_2017/.
11. In 2016, an Indiana transgender woman was shot in the face while their attacker yelled anti-
transgender sentiments. Alleged Hate Group Member Charged in Shooting of Trans Woman in
Indiana, The Advocate (July 17, 2016), available at
http://www.advocate.com/transgender/2016/7/17/alleged-hate-group-member-charged-shooting-
trans-woman-indiana. Across the nation, violence against transgender individuals is on the rise.
Maggie Astor, Violence Against Transgender People Is on the Rise, Advocates Say, N.Y. TIMES,
Nov. 9, 2017.
12. Though the data on violence is staggering, the actual violence against transgender people is likely
much worse, due to the underreporting of crimes. See. E.g. Lucas Waldron, Deadnamed: The way
cops in Jacksonville and other jurisdictions investigate the murders of transgender women adds
insult to injury and may be delaying justice, available at
https://www.propublica.org/article/deadnamed-transgender-black-women-murders-jacksonville-
police-investigation; Emma Keith et. al, Lack of trust in law enforcement hinders reporting of
LBGTQ crimes, available at https://www.publicintegrity.org/2018/08/24/22138/lack-trust-law-
enforcement-hinders-reporting-lbgtq-crimes.
13. The Court of Appeals is clear that these significantly higher rates of discrimination, harassment,
and violence experienced by transgender people as compared to cisgender people (people who are
not transgender) is enough to satisfy that there was clear and convincing evidence that the
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Petitioner would face a significant risk of substantial harm if their transgender status was disclosed
to the public. In re Name Change of A.L., 81 N.E.3d 283, 291 (2017).
14. The Court of Appeals rejected the trial court’s reasoning that Rule 9 was not applicable because
the petitioner had not shown they were subjected to any specific threats or violence because of
their gender identity. Id. At 290-91. Trial courts have no jurisdiction to disregard appellate
precedent. Cf. Ross v. State, 877 N.E.2d 829, 835 (Ind. Ct. App. 2007) (appellate precedent is
binding on trial courts), trans. denied.
15. There—on an evidentiary record substantively identical to that submitted here—the court found
that the significant risk of harm came from the general public being able to access, on the internet,
in perpetuity, information about petitioner being transgender.
2
Id.
II. COURT DOCUMENTS IDENTIFY PETITIONER AS TRANSGENDER, WHICH
UNLAWFULLY DISCLOSES CONFIDENTIAL MEDICAL INFORMATION IN
VIOLATION OF A.C.R. 5(A)(1).
16. A.C.R. Rule 5(A)(1) mandates that records declared confidential by Indiana statue or court rule
must be excluded from public access. Both medical and mental health records are confidential and
protected from public disclosure.
17. That Petitioner’s is transgender is protected medical information. I.C. § 16-39-3-10 declares a
patient’s “mental health record or testimony related to a patient’s mental health” offered in a legal
proceeding to be a confidential court record.
18. Gender transitions involve both physical and social elements. Social elements, such as wearing
clothing more readily associated with a specific gender, changing one’s name and updating their
identity documents to reflect their experienced sex, are therapeutic treatments for the psychological
treatment of gender dysphoria. STANDARDS OF CARE FOR THE HEALTH OF TRANSSEXUAL,
2
A publication notice in a local newspaper lives on past the three weeks in which it is published. All public
notices published in Indiana are archived and searchable though the Hoosier State Press Association. Indiana
Public Notice Search, available at http://www.indianapublicnotices.com/
. Once publication is made or the court
file accessed, it cannot be undone.
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TRANSGENDER, AND GENDER-NONCONFORMING PEOPLE, WORLD PROFESSIONAL ASSOCIATION
FOR
TRANSGENDER HEALTH (7
th
ed. 2011), available at https://www.wpath.org/publications/soc.
19. The records in this case constitute protected health records that Indiana law requires trial courts to
keep confidential. See Ind. Code § 16-39-3-10 (a “mental health record or testimony related to a
patient’s mental health” offered in a legal proceeding is a confidential court record). Trial courts
have no discretion, and therefore no jurisdiction, to order such records be made publicly available.
E.g. Groth v. Pence, 67 N.E.3d 1104, 1112 (Ind. Ct. App. 2017) (“as a matter of law,” records
declared confidential by statute “shall not be disclosed”), trans. denied.
III. BEING OUTED AS TRANSGENDER VIOLATES PETITIONER’S PRIVACY
INTERESTS PROTECTED BY THE ACCESS TO COURT RECORDS RULES AND
THE 4TH AMENDMENT OF THE US CONSTITUTION.
20. The purpose of the Rules on Access to Court Records is, among other things, to protect the privacy
interests of litigants. The Commentary to the Rule recognizes “that unrestricted access to certain
information in Court Records could result in an unwarranted invasion of personal privacy or
unduly increase the risk of injury to individuals and businesses.” Ind. Access to Court Records
Rule 1, cmt.
21. Petitioner has a fundamental right of privacy in preventing the release of their highly personal and
intimate medical and mental health information and in deciding under what circumstances to
release information that has a statistically significant likelihood to subject them to substantial
harm. Whalen v. Roe, 429 U.S. 589, 599-600 (1977); Nixon v. Adm’r of Gen. Servs., 433 U.S. 425,
464-65 (1977) (instructed that intrusions on legitimate informational privacy expectations must be
weighed against the public interest in accessing that information); NASA v. Nelson, 562 U.S. 134,
138 (2011) (reaffirming Nixon balancing test); Denius v. Dunlap, 209 F.3d 944, 956 (7
th
Cir. 2000)
(holding 4
th
Amendment right to informational privacy protects the “clearly established
‘substantial’ right in the confidentiality of medical information that can only be overcome by a
sufficiently strong state interest”).
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22. The United States Supreme Court has recognized that a constitutional right to information privacy
protected by the 4th Amendment applies to the states under the 14th Amendment. Whalen v. Roe,
429 U.S. 589, 599-600 (1977). This constitutional right to privacy means one has a venerable right
“not to have intimate facts concerning one’s life disclosed without one’s consent.” Bartnicki v.
Vopper, 200 F.3d 109, 122 (3d Cir. 1999). In fact, “the more intimate or personal the information,
the more justified is the expectation that it will not be subject to public scrutiny.” Fraternal Order
of Police v. City of Philadelphia, 812 F.2d 105, 112 (3d Cir. 1987). This right to privacy has been
deemed by Federal Courts to include an individual’s gender identity. See Powell v. Schriver, 175
F.3d 107 (2d Cir. 1999).
Denying Petitioner’s Access to Court Records request would make public the fact that Petitioner is
pursuing therapeutic treatment for their gender dysphoria and reveal medical and mental health
information to a large number of disinterested persons with no legitimate interest in that information,
in violation of the 14
th
Amendment to the United States Constitution, I.C. § 16-39-3-10, and the
purpose of the Access to Court Records Rule.
Prepared in January 2020 for use by pro se parties by:
LGBT Law Project
Indiana Legal Services
lgbtgroup@ilsi.net
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STATE OF INDIANA ) IN THE __________________ _______________ COURT
)
COUNTY OF _________________ ) CAUSE NO. ____________________________________
IN RE THE GENDER CHANGE )
OF MINOR: )
)
_____________________________ )
Name of Minor )
)
)
)
_____________________________ )
Petitioner )
PUBLIC NOTICE OF HEARING
Please take notice: Petitioner having filed a Verified Request To Prohibit Public Access and
for Sealing the Record Pursuant to Indiana Rules on Access to Court Records and requesting that
the Court enter an Order excluding the entire case from public access, now AND the Court
having duly examined said motion, hereby sets the matter for hearing on
______________________________________________________________________________
_____________________________ _______________________________________
Dated Judicial Officer
____
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STATE OF INDIANA ) IN THE __________________ _______________ COURT
)
COUNTY OF _________________ ) CAUSE NO. ____________________________________
IN RE THE GENDER CHANGE )
OF MINOR: )
)
_____________________________ )
Name of Minor )
)
)
)
_____________________________ )
Petitioner )
ORDER ON VERIFIED REQUEST TO PROHIBIT PUBLIC ACCESS PURSUANT TO
INDIANA RULES ON ACCESS TO COURT RECORDS
Following a hearing on the matter, held on ________________________________________ the
Court now issues the following Findings and Order:
1. Petitioner has demonstrated by clear and convincing evidence that the requirement of Indiana
Rules On Access to Court Records are met.
2. Petitioner demonstrated that the personal safety interests served by prohibiting public access to
the entire court record of this case outweigh the public access interests served by the Indiana
Rules on Access to Court Records.
3. Permanently prohibiting Public Access to the entire court record is the least restrictive means
and duration to protect Petitioner’s and Minor Child’s personal safety.
THEREFORE, IT IS ORDERED that Public access to the documents that comprise the entire
court record under this case number is permanently prohibited and all Public access to all further
proceedings under this case number is prohibited.
So ordered this _________________________________________________________________
____________________________________
Judicial Officer
Distribution:
_________________________
_________________________
_________________________
_________________________
____
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