HomeMy WebLinkAbout03-0902IN RE:
ROBERT FLOYD BRZOSTOWICZ,
PETITIONER
IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY,
PENNSYLVANIA
NO.f..~- ('~,~,~ CIVILTERM
PETITION TO CHANGE NAME
1. Petitioner is ROBERT FLOYD BRZOSTOWICZ who resides at 5975 Eberly Drive,
Mechanicsburg, Cumberland County, Pennsylvania, 17050.
2. Petitioner has resided at the following addresses for the five (5) years previous to filing of
this petition:
ADDRESS COUNTY STATE
5975 Eberly Drive, Mechanicsburg Cumberland Pennsylvania
3. Petitioner desires and intends to change his name to ROBERT FLOYD BREWSTER.
4. Petitioner provides the following reasons for this request:
Petitioner's last name on his birth certificate was his parent's family name from
their birth country. Petitioner's family never used this name after coming to the United States of
America from their homeland. Petitioner's family used the last name of BREWSTER. Petitioner
has never used the last name of BRZOSTOWICZ at any time in his life. Petitioner will not be able
to collect his social security unless the name on his birth certificate matches the name on his social
security records. Petitioner must obtain a name change to enable him to request to have the name
on his birth certificate changed to BREWSTER.
5. Petitioner states that no credit has been extended to him in the last ten (10) years under
the name of ROBERT FLOYD BRZOSTOWlCZ, and that this change of name is not requested
for the purpose of concealment of identity or for any fraudulent purpose.
WHEREFORE, Petitioner, ROBERT FLOYD BRZOSTOWICZ, respectfully requests
that this Honorable Court enter a decree changing his name from ROBERT FLOYD
BRZOSTOWICZ to ROBERT FLOYD BREWSTER.
Dated: February~,~-, 2003
Respectfully submitted,
LAW FIRM OF SUSAN KAY CANDIELLO, P.C.
usan _Kay (~ndie]l~, Esquire
Counsel forIPetiti/bner
PA I.D. # 64x:IAg~
5021 East Trindle Road
Suitel00
Mechanicsburg PA 17050
(7~7) 796-1930
VERIFICATION
I, ROBERT FLOYD BRZOSTOWICZ, hereby verify that I am the petitioner herein, and as
such, verify that the information contained in the petition is true and conect to the best of my
kno~edge, informafion and belief. This verification is made subject to the penalties of 18 Pa. C.S.
4904 relating to unsv~rn falsification to authorities.
ROBERT FLOY~D BRZ(~STbWICZ j
IN RE:
ROBERT FLOYD BRZOSTOWICZ,
PETITIONER
IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY,
PENNSYLVANIA
NO. 03-902
CIVIL TERM
AND NOW,
Petitioner's documents and the Petitioner's
thio~,- - of ~ , 2003, after a review of the
request of the Petitioner to change his
name from ROBERT FLOYD BRZOSTOWICZ to ROBERT FLOYD BREWSTER is
hereby GRANTED AND DECREED.
By the Court:
~Judge