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HomeMy WebLinkAbout07-628307-1.1P,3 Name., j Address: City: Phone: _ Email: U'M IN RE: NAME CHANGE OF : IN THE COURT OF COMMON PLEAS ?JY 1? :bmbalan ?WMNNSYLVANIA 14 d : NO. PETITION FOR CHANGE OF NAME TO THE HONORABLE JUDGES OF SAID COURT::,, n?,,? The Petition o rOl ? hi. 3lX.:l I L rg? l(??[T E- , respectfully represents: 1. Petitioner is who resides at 1 Wed 1,A ur'A kf)?Ag f I I PR FIN L 2. Petitioner has resided at the following addresses for the five (5) years previous to filing of this petition: Revised 10-06 © Dauphin County Court of Common Pleas 3. Petitioner desires and intends to change his/her name to: 4. Petitioner provides the following reasons for this request: l? lcc?-?na.?.e (Alta fAer V'QS 6D C i In r U+Mh" 15 n? U-)JOIV 5 lob 5. The proposed change in Petitioner's name if granted will not be detrimental to the interests of any other person and is not against public interest. 6. The petition is not filed to defraud creditors. 7. WHEREFORE, Petitioner requests the Court, pursuant to the Act of December 16, 1982, P.L. 1309, No. 295, § 2, 54 Pa.C.S. § 701, for the following: a. to fix a hearing on this Petition; b. to direct that notice be given on this Petition and hearing; and c. to enter a decree changing the petitioner's name from SI ATUR O PETI IONE Revised 10-06 © Dauphin County Court of Common Pleas VERIFICATION I ( ` I l w? , kwl ti , verify that the facts set forth in the PETITION FOR CHANGE OF NAME are true and correct to the best of my knowledge, information and belief. I understand that the statements herein are made subject to the penalties of 18 Pa.C.S. § 4904 relating to unsworn falsification to authorities. It) 2(0-b-1 Date Revised 10-06 © Dauphin County Court of Common Pleas `-• N .ism; 1 01. 42PJ 61tu, t 4 , Name: L. ?' r r '? ?• Address: mQ Hnx? A-q --N*- CCity:0-amp 1 , PA Zip: gn?n u I i Telephone: K r 5 1 `'1-U ) 5 v Email: (?'? names C?c. ? e??csn ??ctQs?cu'?- Plaintiff v. Defendant IN THE COURT OF COMMON PLEAS PENNSYLVANIA UCYI' `fLt NO. CV CIVIL ACTION -LAW PETITION FOR LEAVE TO PROCEED IN FORMA PAUPERIS TO THE HONORABLE JUDGES OF SAID COURT: Pursuant to Pa.R.C.P. No. 240, 1 hereby certify that I am without financial resources to pay the costs associated with my case, and therefore believe that I am entitled to proceed in forma pauperis. In support of my petition, I have attached to it a certification of indigency and incorporate it herein by reference, a certification which fully and truthfully describes my overall financial condition at the present time. WHEREFORE, the undersigned asks leave of court to proceed in forma pauperis, without the need to pay any costs in connection with the instant action. Respectfully submitted, lb- (H)l Date Revised 10-06 © Dauphin County Court of Common Pleas ;ig of etitione Name: JWA i L ffleAddress: 1 o r MaBafd U W A City: onmo A ? ? , PA Zip-PA V) 01 Telephone: )?A q05tp oV "-? -316'K Email: TV). V'2 o? &"Sm O?J? urn IN THE COURT OF COMMON PLEAS Plaintiff 144PENNSYLVANIA V. NO. CV : CIVIL ACTION - LAW Defendant CERTIFICATE OF INDIGENCY 1. I am the (Plaintiff/Defendant) in the above matter and because of my financial condition, I am unable to pay the fees and costs of prosecuting or defending the action or proceeding. 2. 1 am unable to obtain funds from anyone, including my family and associates, to pay the costs of litigation. 3. 1 represent that the information below relating to my ability to pay the fees and costs is true and correct: 3( (a) Name: A 1, L 1 1 IfiY n% R-1 Address: iot? At?-W Revised 10-06 [ ` f ` © Dauphin County Court of Common Pleas' r ` I M L? l " Social Security Number: C2, I I - d - .1 l? (b) Employment: If you are presently employed, state Employer: 1>'fi?J( ?) l Address: 5D POW Z+- Salary or wages per month: I , I?JIJ_ ?UVt'?1 Type of work: j 1 ?a(1 A? If you are presently unemployed, state Date of your last employment: Salary or wages per month: I XDA 1 Type of work: _ h ) COAA= (c) Other income within the past twelve (12) months Business or profession per month: ?)(AM Other self-employment per month: OM A Interest per month: NUVU Dividends per month: K-) OWL Pensions and annuities per month: Social Security benefits per month: Support payments per month: bded LA2.00 I- wo-V- tt iii e? Disability payments per month: ?J? 1 tr'l ?u Unemployment Compensation and supplemental benefits per week: KA MA' Workers' Compensation per month: 11 Q8-/1A Public Assistance per month: U UAti Revised 10-06 © Dauphin County Court of Common Pleas Other per month: ? )??. (d) Other contributions to household support Wife/Husband Name: Q VwU If your wife/husband is employed, state: Employer: Uuy' . Salary or wages per month: h }? Type of work: Contributions from children: ??- Contributions from parents: Other contributions: 0"u- (e) Property owned Cash: UN-IL Checking account: 160.00 Savings account: ?Ab , Certificates of deposit: ?Q) - Real estate (including home): Motor vehicle: Make: IkS?A?- Year:2 Cost: Amount Owed: D O Stocks; bonds: ?Y U Other: (f) Debts and obligations - average ner month Mortgage: a( a m6r) ,i (?dn Rent: ? t f vt 1n dL) e, -v A- firUVVrC (- (6Vne L VI 61rnCe- 4- FC4fe- z Uzcws A D Loans: 0cl Revised 10-06 © Dauphin County Court of Common Pleas Other: ?( XIL (g) Persons dependent upon you for financial support Wife/Husband Name: ALL- Children, if any: Name: Age: Other persons dependent upon you for financial support (such as parents, grandparents, etc.): Name: 1A N.i Relationship: ?) ((? 4. 1 understand that I have a continuing obligation to inform the court of improvement in my financial circumstances which would permit me to pay the costs incurred herein. 5. 1 verify that the statements made in this affidavit are true and correct. I understand that false statements herein are being made subject to the penalties of 18 Pa.C.S. § 4904, relating to unsworn falsification to authorities. 10- 419-0 Date Signat r of Petitioner Revised 10-06 © Dauphin County Court of Common Pleas r? C` ? ?w ? ?... p -ra i.? e-?? 1-?? r=" "?J ? ?? ?? !? s X ?? ?? ?? f ' IN RE: PETITION FOR IN THE COURT OF COMMON PLEAS OF CHANGE OF NAME CUMBERLAND COUNTY, PENNSYLVANIA OF BRANSON EUGENE SALSBURY 07-6283 CIVIL ORDER OF COURT AND NOW, this 7th day of November, 2007, upon consideration of the Petition for Leave to Proceed in Forma Pauperis, IT IS HEREBY ORDERED AND DIRECTED that the Petition is GRANTED. By the Court, /Odi L. Mehaffie Petition bas M. L. Ebert, Jr., VINVAIAS N3d XMM, S C :O! WV C 1 AON LODZ 301•_1-40-G31W ,I . It IN RE: PETITION FOR IN THE COURT OF COMMON PLEAS OF CHANGE OF NAME CUMBERLAND COUNTY, PENNSYLVANIA OF BRANSON EUGENE SALSBURY 07-6283 CIVIL ORDER OF COURT AND NOW, this 7th day of November, 2007, upon consideration of the attached Petition for Name Change, a hearing is scheduled for Friday, February 29, 2008, at 9:30 a.m., in Courtroom No. 5, of the Cumberland County Courthouse, Carlisle, Pennsylvania. IT IS FURTHER ORDERED that notice of the filing of said Petition and the aforesaid date, time and place of the hearing be published once in the Cumberland Law Journal and a newspaper of general circulation in both Cumberland and Dauphin Counties at least 10 days prior to the hearing, as well as served upon Robert Salsbury, the child's natural father. Petitioner shall comply with all other requirements of the C.C.R. P. 5, 54 Pa. C.S. §§701 et seq. By the Court, M. L. Ebert, Jr., odi L. Mehai Petitioner bas J d14'???r?'i(1J wan- ?PAJ IN RE: PETITION FOR IN THE COURT OF COMMON PLEAS OF CHANGE OF NAME CUMBERLAND COUNTY, PENNSYLVANIA OF BRANSON EUGENE SALSBURY 07-6283 CIVIL TERM DECREE FOR CHANGE OF NAME ORDER OF COURT AND NOW, this 29th day of February, 2008, after hearing in the above-captioned matter and on of publication of notice as required by law, there is no legal or other objection to the of the Petition, the Court does find that it interest of this child, age 5-years-old, and of the Act have been satisfied. presentation of proof and it appearing that jranting of the prayer is in the best that the requirements IT IS ORDERED AND DECREED that the name of Branson Eugene Salsbury is hereby changed to Branson Eugene Mehaffie. By the Court, \\ -t " M. L. Ebert, Jr., J. Jodi L. Mehaffie, Petitioner 611 Mallard Road, Apt-4 Camp Hill, PA 17011 pcb - 7i, r S