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EXHIBIT C
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IN THE MATTER OF:
DAVID DRUCE TSUDOT A
and
PATRICIA LYNN TSUIlOTA
IN THE COURT OF COMMON PLEAS
CUMRERLAND COUNTY, PBNNSYLVANIA
CIVIL ACTION
.} /) ( '-Ti-
NO,: ((/1" ,11'!"'1J LilA [r.l"1
PE'l:ITION liaR NAME CIIANGE
Petitioners, David Ilruce Tsubota and ('ntricla Lynn TsullOtU, husband and wife, through their
counsel, Reager & Adler, PC, p~lltlons this COUl'tto legally change their name and in that regard,
avers the following:
I. Petitioners nre David Ilnlce Tsubota and Patricia Lynn Tsubota, 2948 Maple Road,
Camp Hill, Cumberland County, Pennsylvanlu 170 II,
2, Petitioner, David Bruce Tsubota, Is an adult individual with a date of birth of August
4, 1954. and Social Security Number 383-66.0873,
3, Petitioner, Patricia Lynn Tsubota,Is an adult individual with a date of birth of March
21, 1967, and Social Security Number 592-20.1917,
4, Petitioners have resided at 2948 Maple Road, Camp Hill, Cumberland County,
PeMsylvania since July, 1996, Prior to that date, Petitioner resided at 53 Fairfax Village, Harrisburg,
PA, 17112; 1500 Worcester Road, Apt, 503, FraminghaJl1, MA 01701; 2401 Spring Creek Parkway,
Piano, TX 75023; 619 Fulton Toad, Tallahas~ee, FI 32312.
5, Petitioners have a minor son named Matthew James Tsubota, with a date of birth of
March 29, 1995 and with Social Security Number 028-78.687),
6, Petitioners have an unborn child that is due around September 30, 1997,
7. Petitioners seck A name change to "David Bnlce Ilutler" And "Patrlda Lynn Butler",
respectively, because they wish to disassociate themselves from the name of husband's estranged
father with whom he has not had contact with since 1964 and take the maiden name of his mother.
8, Petitioners seek a name change of their minor child to "Matthew James Butler" In
accordance with 54 Pa,C,S. ~703(a),
9, Petitioners seck the name changer prior to September 30, 1997 so that the Birth
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