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PENNSYLVANIA STATE POLICE
FOR CENTRAL REPOSITORY USE ONLY
(LEAVE BLANK)
"'1 ~ '1l4 14 IOnt
REQUEST FOR CRIMINAL RECORD CHECK
,.,.,., Oil "'''NT LUIIL" WitH INti.
PART I: TO BE COMPLETED BY REQUESTER
DATI 0' "IQUIIT
III.fUH~""t)N'NIH liE WllEIl H)II.,"~I!HiTEII OI.L'r1
,,~ 'I 'K
NAME OF REQUESTER
'j 1\ ~ I
f \ ";1, y._
ADDRESS
( ( _) _~l
1\
\'" ~(\ "\\/1..
CITY ~,F""'\.\)
I A~~r\ I
~J" STATE )\\
ZIP \ 'e, l J
IP~
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~EG\J,E5T~M 1pe:,'lTlfl~" TI9'.
tCH!Ctc; ONI ILOC"-'
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o
INDIVlDUAUNONeltlMINAL Juant!! "OlNey .INCLOII A CI"TUIIID CH(cK/MONIY CI'DlIt IN T"."MOUNT 0' 110,00 '",YAIILI TO
..COMhlONW....L 'H 0' 'INHIVI.'YANIA,~ 'HI '1111 NON""UNC.'LI
"'DO NOT SEND CASH OR PERSONAL CHECK'"
NOHCIlIMINAL JUITlel AOINeY.'1E IX',....'
HAMlJlUftJl!CT 0' "ICO"D CHICK:
ILAIT)
1'lltIT)
tW'DOll1
')/'-\'1 il( (<..
-',,, kL \
L'I"-''''':'
\U, "jl( -Le(.')
DATI! 01' InnHlOOej:
q 120lb'
.IX
(\)",;ll\"-\L \ ~
~
",lei
'-.>.JT--:<;L
Il"".{'",
MAIOIN NAMI AHOIOft ALIAIIIi
IOCIAl IICUlmv NU".'" IIOCI
RaSON '0" Il:IQUlllT
ICHICK ONlllOCl(1
o EMP,OYMIHT
o ~I~I!A~MS P~OHIBlTION CHA"INOE
o INDIVIDUAL ACCUS AND ~lV1EW BV SUBJECT O~ ~ECOIID CHICK Oil LIOA, IIIPIIIOlNTATIVIIA~~IDAV1T O~ LIOAL IIIPllllENTATION ATTACHlDl
[Sl OTHI"'I'~ECI'Y) b~<\ l'. ~., "'4,,\ (L'''-I(\.' (~d'(J\( l \1"'''J'-.C,
NOTE "~NO "e:COftO" "I!I~NSI""Y TAKI TH"II WIlKS TOP"OCIIS
or" TM"'" Ii "HO "rCO"D" "IIIPONII
"IOUISTI" CMICKUST
DID YOIJ INTI" THI! fUll NAMe:. DOl, AND IOC1
010 YOll I!NCLOSl THI! 110 00 '1I7ICI,nl'IIO CHI!CKlMONIY O"OI!"1
" THII 'otlIM II HOT ll!Ollll OR HOT '"OPlltL or COMPLITtD, IT
Nt.~QJ9~lltI!QUESTI"
Anllt COMPLETION. MAIL TO
'''00 NOT SEND CASHIPERSQNAL CHECK'"
PENNSYLVANIA STATE POLICE CENTRAL REPOSITORY.ll4
UOO ELMERTON AVENUE
HARRISBURG, PENNSYLVANIA 17110-1711
(717) 713-1173
DILl YOU INTE" YOU" CONPL!TI "aDltUS INCLUDING liP COOl
ANO TELIPHONl NUM&1ft IN THI et.OCItIl P"OVIOE01
ORY RESPONSE
'''DO NOT
IHQUlftYlDllSlSlMIHATID IY
110 NO
NO RECORD
o CRIMINAL RECORD ATTACHEO
THIIHPOIIIM"TIOH DlaI,JIlINATED BY THI CINTltAL ItIPOSITOftYI$ IIAIIID 1I0lILY ON
THI 'aLLOWING IOINTI'II!I'5 THAT MATCH THOal 'U"NIIHIO IY THI "lOUUTI"
0 NAME 0 SOCIAL SECURITY NUMBER
0 DATE OF BIRTH 0 RACE
0 SEX 0 MAIDEN/ALIAS NAME Il)lflECTG~ CENTR,ol\.. REPGSITCR'fl
Th' "uponll I. b..,d on I camp.ulon or d.l. provldld by thl rlqul.t" In P.r11 .g.lnllln'orm.t1on conl.lned In the '"I' of Ihl P.nn.yl....nl. SI.I. Poilu Clnl,.,
fhpo'llo.-y onl~. Thl '.nn.yt...."I. 11.11 Pollet ,upon.. dot. nol pr.e1udllhl 1.1.llnet of crlmln,l rlcord. which mlahl b. conl,lntd I" It'l. "polllorlll of othl' loc,l,
.t.le, 0' r.d.,.' cUmin.' JUIUCI aalncl...
..
bP,ld.[.1I111
PENNSYLVANIA STATE POLICE
FOR CENTRAL REPOSITORY USE ONLY
(LEAVE BLANKI
REQUEST FOR CRIMINAL RECORD CHECK
1)'''1 OM '''''H ~e911".y ~nH1N~
tlt.fOHMATlOH 'hilL UE WilEn TO IIE(~uF.6'[ll ONLY)
CA,. 0' "lour"
f-,.)\'1hl.,
PART I: TO BE COMPLETED BY REQUESTER
NAME OF REOUESTER
V. I ,~"l'1I1 '._'.)'1 r't.11
ADDRESS
k..> !J (I.
'\,)t->~\( \
f\ "c.-
CIl,. Ll! t-'\l) '/ ~.) C, STATE I) \\
A~'" COOl: C<lNT&CT Tlll~HON' NU.....~:
III I hill h 10.1 I oll( I "51'--) I
ZIP 1-'<:)\\21
~~Qyt;!i~P! Iptt!J!fl~~Jl9~
ICHlete. ON' ILOCt<1
f1
o
INOIVIDUAUNONCfllMIHAL JUITICIAQIHCY . IHCLOII A CII""IID CMICKlMONIV 011I0111I IN fHIAhk>UNT 0' 110,00 ,...v....U TO:
"cOMMOHWIALTH 01' 'fHHIYLV"'NIA~ THI'II! IIHONfll'UHDASLI
"'DO NOT SEND CASH OR PERSONAL CHECK'"
HONC"'MINAL JUlnel AorNC\' "11 lUMP"
HAhll/IU..,lCT 0' IIlIICOIllO CHICK:
fLAITI
('IIllTI
IMtDOLl1
F\1ViY. c '"
---- '
~)I'l 'I~L"\<"
\C.C"-\I-J(l II
MAlorH HAMI AHOla" "LlAlU
SOCIAL UCU"tTY HUMlllfll&OCl'
\'GIJ' Gll ,I-\C\l.(")
DATI 01 IlfllTH lDOII:
i\LL\b')
...
M
RACI'
'Ii I\X
1\ /1 ti-
IIUION 'Oil "laUIST
ICHICI< ONIILOCI<)
o IMPlOYMINT
o 'I~"'~MS ~~OHI"TION CHAlLlNOI
o 'NolVloUAl ACCUSANo ~IVIIW BY SUIIJICT 0' ~ICORo CHICK O~ llOAl ~IPI\nINTATIVIIA"IDAVlT o'LlOAL IIIPIIII.NTATION ATTACHID)
J:ll OTHI~ISPICI'YI (-,,.. I ,!"'\,0,\~",(j 1''';C'' (Ni\t'l (\If>,"'C-l)
NOTE : :~c":;;'O" "EI~H~::::! ~~;.T.H:~!", ~~,II<I TO '''OCIII.
"founnll CHICI<UI"
010 YOU IHfl" THI 'ULL HAMI. 008, AND 10<:7
010 YOU INCLolI THI "000 '1I7ICIIITI"ID CHICt<JMONIY O"Of'"
~II~~I~:~M II HOT LIOIILI Of' NOT 'fllOPl"LY COM~lTIO,lf
AnI" COMPlITION, MAIL fO
"'00 NOT SEND CASHIPERSONAL CHECK"'
PENNSYLVANIA STATE POLICE CENTRAL REPOSITORY.1U
liDO ELMERTON AVENUE
HARRISBURG. PENNSYLVANIA 17110-1711
(717)713"173
DID YOU INTI" YOU" COMPUTI ADDRU5lNCLUDlNO ZIP COOl
AND flLfl'ttONI NUMIIIlIIN THI aLOCl<1 'fl:OVlDl07
PART II: CENTRAL REPOSITORY RESPONSE
"'DO NOT WRITE BE OW THIS I IN.....
IN'~MATION DlllIMIHATlo
V NO RECORD
o CRIMINAL RECORD ATTACHED
INCUI"YIDIIIIMINA TIo I...
~
IIONO
THIIN'Ofl:MATtoN DlIIIMINATED IY THI CINTfl:AL "1I'O\lTOf'Y II BAllO 10LIL YON
THI 'OLLOWtHO 10INTt"I'" THAT MATCH THOll 'U"NI8HID IV THI "IOUUT",
,I:I.\I"'O.Y
.
0 NAME 0 SOCIAL SECURITY NUMBER j
0 DATE OF BIRTH 0 RACE
0 SEX 0 MAIDEN/AI.IAS NAME IOIREGTCR CENTPAL REP051TOfnl
Th. "upon..ts b...d on I complrllon of dltl provkt.d bV the r.quut.r In 'al1l .galnlllnformltlon conlalned In Ih. filII of Ih. 'Innlylvanla 1111. PoUct Clntr.1
".poIltOfy only, Th. '.nnIVlvanll 1111. Police f..pon.. do.. not pr.clud.lh. ulll.nc. rI c,fmlnAI r.cordl which mlgnt b. contAIned In th. r,polltorln of olher loul,
Iflle, or fed.ral eflmtnaljUIlIc. 1'lI.nel'l,
., "II'>
.
,\
$tate of Penns\,?l\?anta,1.81
CDUNTY DF' DAUPHIN r
I/./~_._.!:':: ~""-_.- .....-
Prothonotary of the Court of Conunon Pleos In and for Bald county,
do hereby certify that oCtor dlllgcnt scnrch by me made, I fInd no
,
.-. ........ -- ......~... -......- .....-,.--- .... ...---~ -..,. ---.....--- . ---...-- ~- - - -... - -.. -,- '. -- - - -- - --.. - --- -.. ,..... - ............
of Record In said court arains~ ._d,~__~ ~ ~
~~;_ I _~__~_~~~:f._:'/u~_
~_____n .__nn______n_.nn.____ ,__.."_n_n__...n..._.. ._____nn_
IN WITNESS WHEREOF, I hove hereunto Bet my hond and couBed the Beol of sllld court to
be IIlftxed lit Harrisburg this____.I~_~__.___day of.
___H_iJ;)~__
l'rothonol.ary
PNOTHON... 'I
,
,
.
..... ..J
Proof of Publication of Notlee In The Patriot and The Evening News
and The Sunday Patriot-News
l'Dd.r .4.rt No. UT, .\PJlttJud Ma)' '''. 1".:8.
C'I/mmll"wlnltll IIf P,,.,.8/1/t'/I,.ia,} .
('l/Im'If IIf Il/luphill ".,
..,.................,....J.1..\,~,').;,~,~>..L~l.~;,.!:.~.~:.":.................. .........lll'lnlf duly ,wnrn accor,tlng to law, del>'lHes Rnd lIya:
^Utit. c'ontrl'111,\r
Thst he Is the ...........................of Till': PATH lOT . l'E\\'S CO" II corporation orl1l1nl1..>d and exl.Unlr
under the laws of the Commonweulth of PenuHylvunln. with Ita I'rinclpal ofllee and plllce of business at
812 to 818 Market Street, In the City of Ilnrrl<hurK. County "f lllllphln, State of PennHylvanlll, OWMr
and publlaher of TilE PATIIIOT IInd TilE E\'E1>'I/I:(; 1>'E\\'S IInd the SUNDAY PATRIOT. NEWS
newspapers of Ireneral clrculution, prll1t.',1 IInd IlIIiJllal1<'d lit ~12 to 818 Market Street, In the City,
County and State aforeHuid; thllt TilE PATH (1'1' IInd TilE EVENING N~:WS and the SUNDAY
PATRIOT. NEWS were eHtllbll,h.d March 4th, l~r)4, IInd I'.'bruary lMh, 1917 and September 18th,
1049 respectively, and all hll\'" heen contlnuouHly publlHhed ever Hlnce:
That the printed notice or puhli<'IIUon which Is .ecurely attached hHcto I. exactly as printed anrl
13tl1 day of S.'ptel1loer
published In their rell'Ular e,lltion. and I.sue. which nppl'ared on the ..........................................................
J'J%.
........................,.....,...,.........,............................"".,....,.....,....................".......................................................'............',..
That neither he nor Huld rompuny la Intereated In the .uhJect matter of .ald printed notice or adver.
tlslnlr, and that all of the ullegatlona of thl. stlltement as to the time, place and character of publkatloll
are true; and
That he haa personal knowledge of the facta nforeallld and Is duly authorl1.ed and emr.owercd to
verify thla atatement on behalf of The Putrlot-News CI/. aforeallld by virtue and purHuant 0 a reaolu-
tlon unanlmoualy paaaed and adopted severally hy the stockholdera IInd board of dlrectora of the "aid
Company and subaequently duly n'\:orded in the olllce for t[recordln\" of Deeds In and for aald County
of Dauphin In Mi".,.lla""'",, Illl"~ "M". \ ,,1,,11I" II. I'a~,' ;11. t . _ )
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H,mlburg, D.)lJphm Ccu'lly
My co MJ~fIlW1~!I/ kf,'."'A!!~.~.L.'.?;!~.. ...................
StatementoTP;A1Yerflslng Costs
Cllantt 0/ Namt
HOTICIII HI".IV GIVIN tI'IOtonJuty I..
,.... the ""man Of ktnM'fh /4, Anycter.........
L. In...... WOI tIIld In tN Court or Common".
of CumMtIDnd County. r....I"", 011 lit.... te
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To TilE PATHlOT.NEWS CO., Dr.
I'"r p"hll,hlnl{ the n"tlce or publlcution IIttaehed hereto on the
above atllted dlltes - $........,~,~..:.~.c.).......
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Problltlrlg allme
Totlll
Publisher's Receipt for Advertising Costs
THE PATRIOT-NEWS CO., II1IhliHher of TilE PATHlOT lln,1 THE EVENING NEWS and the
SUNDAY PATRIOT.NEWS, "'WHfl"fle,'" of 1{('Ill'I'1I1 d,'('ulntioll. he..eby IIrknowledl{e receipt of the
aforesaid notice llnd publicHllon coatH 1111<1 ccrtlfle" thllt the Hllme have been duly paid.
TilE PATRIOT.N~:WS CO.
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IN THE MATTER OF PETITION
FOR CHANGE OF NAME OF
KENNETII ANDREW SNYDER AND
JANET LYNN SNYOER
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
NO. 96-4011 CIVIL TERM
AFPIOAVIT
I, Kenneth A. Snyder and Janat L. Snyder, do depoae and awear that the following
are steps the undersigned petitiom!rs lune tsken to reS88ure the court of our
purposes in seeking a namu chsngel
1. Submitted a request for criminal records chuck at the Pennsylvania
State Police Headquarters building at 1800 Elmerton Avenue, Hbg. PA
Attached hereto lInd incorpornted herein is n copy of the above
request and response to said request
2, Received a notori~ed statement from the prothonotary of the County
of Dauphin which indicates that there are no Liens. Judgements.
Federal Tax Liens. or Secured Transactions held against petitioners.
Attached hereto and incorporated herein is a copy of the above
request and response to said request
3. Pursuant to Order of Court dated July 18. 1996, petitioners have
published proper notice of petition for change of name in the
Cumberland Law Journal and the Harrisburg Patriot News for at
least 10 days prior to the schedul" dated herein. Attached hereto
is a copy of the proofs of publication from the aforementioned
publications.
This request for chango of nnme is being made in order to reflect the name of
petitioner Kenneth A, Snyder's mother who is solely responsible for petitioners
upbringing, Petitioner seeks to change name to honor his mother's self sacrifice
and dedication in raising her children and petitioners unequivocally state thet
this petition is not a means to evade any creditor or law enforcement agency.
Dntel
q /r J ~_________.
Jene
Enclosures
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IN THE MATTER OF PETITION
FOR CHANGE OF NAME OF
KENNETH ANDREW SNYDER AND
JANET LYNN SNYDER
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUN~Y, PENNSYLVANIA
96-4011 CIVIL TERM
ORDER OF COURT
AND NOW, this 23rd day ot September, 1996, upon
con.ideration ot the Petition For Chango ot Name, and tOllowing
a hearinq, the petition i. granted, and the name ot Kenneth
Andrew snyder i. changed to Kenneth Andrew Stratton.
wcy
DUFFIE, ESQUIRE .
Petitioners t!""~
/()/JIf'
J~
MARl( C.
For the
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