HomeMy WebLinkAbout01-0964
HAROLD S. IRWIN, III, ESQUIRE
ATTORNEY ID NO. 29920
35 EAST HIGH STREET
CARLISLE PA 17013
(717) 243-6090
ATTORNEY FOR PETITIONER
IN RE:
BRYAN ALLEN LINEBAUGH,
a minor,
: IN THE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY, PENNSYLVANIA
: ORPHANS COURT DIVISION
: NO. 01 - 811.-. TERM
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NOW, thiS'J,q ':: :RD ber, 2001, in consideration of the within petition
and the attached consents, and on motion of Harold S. Irwin, III, Esquire, attorney for
petitioner, it appearing that there is no legal objection to the granting of the prayer of the
petitioner,
IT IS ORDERED AND DECREED that the Pennsylvania Department of Health,
Division of Vital Records, amend the birth record for the child, Bryan Allen Linebaugh,
by changing the name of the child to BRYAN ALLEN DUNBAR and adding the name of
the natural father, GREG ALLEN DUNBAR, and to issue a new birth certificate to
Kimberly Lynn Capron reflecting such changes.
By the Court,
J.
. I
IN RE: : IN THE COURT OF COMMON PLEAS OF
BRYAN ALLEN LINEBAUGH, : CUMBERLAND COUNTY, PENNSYLVANIA
a minor, : ORPHANS COURT DIVISION
: NO. 01 - CIVIL TERM
PETITION TO AMEND BIRTH RECORD
AND FOR ISSUANCE OF A NEW BIRTH CERTIFICATE
NOW comes the petitioner, Kimberly Lynn Capron, by her attorney, Harold S.
Irwin, III, Esquire, and presents this petition to amend the birth record of Bryan Allen
Linebaugh and for the issuance of a new birth certificate, representing as follows:
1. Petitioner is Kimberly Lynn Capron, an adult individual residing at 319
South Baltimore Street, Mt. Holly Springs, Cumberland County, Pennsylvania 17065.
2. Petitioner is the mother of Bryan Allen Linebaugh, a minor child whose
date of birth is February 8, 1998.
3. Petitioner was married to Donald E. Linebaugh, an adult individual now
residing at 707 Highland Avenue, Mt. Holly Springs, Cumberland County, Pennsylvania
17065, from June 15, 1985 through the date of their divorce on July 10, 1998.
4. At the time of the birth of the child, petitioner was still married to Donald E.
Linebaugh, but the two had been separated since June, 1996.
5. Upon the birth of the child, the birth records were completed indicating
petitioner's married name as the last name of the child and no information was provided
regarding the name of the father of the child. A copy of the child's current birth record is
incorporated herein be reference and attached hereto as Exhibit "A".
6.
1998.
The child has resided with the petitioner since his birth on February 8,
7. Petitioner and the child now reside with the natural father of the child,
Greg Allen Dunbar, and petitioner has resumed the use of her maiden name Kimberly
Lynn Capron.
8. Petitioner and all parties involved now wish to have the birth record for the
child corrected to provide that the child take the name of his natural father and that the
name of the natural father be added thereon.
9. Petitioner has attempted to accomplish this by the execution and filing with
the Division of Vital Records of an Acknowledgment of Paternity by the natural father,
Greg Allen Dunbar. A copy of the Acknowledgment of Paternity is incorporated herein
be reference and attached hereto as Exhibit "B".
1 O. However, since petitioner was married at the time of the birth of child, the
Division of Vital Records requires an Order of Court directing that the requested
changes be made to the birth records for the child. A copy of the April 27, 2000 letter
from the Division of Vital Records is incorporated herein be reference and attached
hereto as Exhibit "C".
11. The consents of the natural father, Greg Allen Dunbar, and of the putative
father, Donald E. Linebaugh, are incorporated herein by reference and attached hereto
as Exhibits "D" and "E", respectively.
WHEREFORE, petitioner requests your Honorable Court enter an order directing
the Pennsylvania Department of Health, Division of Vital Records, amend the birth
record for the child, Bryan Allen Linebaugh, by changing the name of the child to
. .
BRYAN ALLEN DUNBAR and adding the name of the father, GREG ALLEN DUNBAR,
and to issue a new birth certificate to Kimberly Lynn Capron reflecting such changes.
HAROLD S. IRWIN, III
Attorney for Petitioner
September 18,2001
35 East High Street
Carlisle, PA 17013
(717) 243-6090
Supreme Court 10 NO. 29920
VERIFICATION
The foregoing petition is true and correct to the best of my knowledge,
information and belief. I understand that false statements made herein are subject to
the penalties of 18 Pa.C.S.A. Section 4094, relating to unsworn falsification to
authorities.
September 18,2001
OA TE OF FILE
BIRTH 02-0-S-9.3 NO.
('-10 OAY Yl;.4.R'
DATE
FILED
COUNTY OF DATE
BIRTH DAUPHIN ISSUED
3093920-98
02-13-98
IJ.lO OAY. yEAR)
OS-~1-98
IJ.lO ~,.y, Vl;.4.R)
NAME
BRYAN ALLEN LINEBAUGH
SEX
MALE
FATHERS NAME
IN=ORMATION NOT RECORDED
MCTHEP3 ~AID~N NAME
~IM3ERLY LYNN CAPRON
Th.S is to certify tllal t,.,is IS . If\le COlly ot the record ."'Icll is on tile in Ilia Pennsylvania Department 01 Heallll,
.n accordance Wllh ACI 6ll. P.L ~. approved by Ine General Assembly. Ju". 29. 1953.
~II~
CHARlES HAAOEsrER
STATE REGISTRAR
2485096
The information appearing on the certified copy of birth is exactly transcribed from information contained on the original birth
certificate as filed with the Office of Vital Records.
If you wish to correct the certified copy issued. please complete the lower portion of this form in thp. presence of a nC'tarizing official
and forward to th~ Division of Vital HecorOs. P.O. Box 1528. New Castle. Pa. 16103.
PLEASE SUBMIT DOCUMENTARY EVIDENCE TO SUPPORT THE CHANGES REQUESTED SUCH AS A COpy OF A BAPTISMAL
RECORD, EARLY SCHOOL RECORD, MIUTARY RECORD. INSURANCE POLICY OR MARRIAGE LICENSE.
DATA
ORIGINAL RECORD NOW READS
I
I
CORRECTIONS DESIRED
(print full names. dates, other)
1
NAME OF SUBJECT
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DA TE OF BIRTH
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OTHER ERROR
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COMMONWEALTH OF PENNSYLVANIA . DEPARTMENT OF PUBLIC WELFARE
BUREAU OF CHILD SUPPORT ENFORCEMENT
PO BOX 8018. HARRISBURG, PA 17105-8018
ACKNOWLEDGMENT OF PATERNITY
For a Child Born to an Unmarried Woman Pursuant to Act No. 1993-62 and Act No. 1997-58
Birth Certificate D
DAUPHIN
P A
PLACE COMPLETED (HOSPITAUCAO CODE/LOCATION):
CARLISLE, PA
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Voluntary acknowledgment of paternity by the father in completion of this form. with the consent of the mother, gives the
father all the rights and duties as to the child which he would have had if he had been married to the mother at the time of the
child's birth. The child shall have all the rights and duties as to the father which the child would have had if the father had been
married to the mother at the time of birth. By signing this document, I acknowledge that I have read and have been orally advised
of the alternatives to, the legal consequences of, and the rights, responsibilities. and obligations of acknowledging paternity.
Either party signing this document may rescind this document by submitting a signed notice of rescission to the Department
of Public Welfare (address at top of form) within the first 60 days of the date after the Acknowledgment of Paternity is
signed or prior to a proceeding relating to the child (whichever is sooner).
After the expiration of the 60 days, the Acknowledgment of Paternity may be challenged in court only on the basis of
fraud, duress or material mistake of fact, which must be established by the challenger through clear and convincing evidence. An
order of court shall not be suspended during the period of the challenge. except for good cause.
CONSENT OF MOTHER
~\
I, ,.-. . , hereby consent to the acknowl-
(PRINT FUll NAME OF M THER)
edgmentofpaterni~that is the
(PRINT FULL NAME OF FATHER)
father of my child named above, and further state that I was _married at the time of this child's birth. I
understand that false statements made herein are subject to the penalties of 18 Pa. C.S. 94904 (relating to
unsworn sification to au rities).
~ PA 17065
Witnessed by: 03 ;/ Y / 00
(DATE WITNESSED)
~
ISOCIAL SECURITY NUMBER) (MOTHERS DaB)
x
Address of Witness: 35 E A S T HI G H S T R E E T, SUI T E S 2 0 1 / 2 0 2, CAR LIS L E, PAl 7 0 1 3
ACKNOWLEDGMENT OF FATHER
I, I freely and voluntarily acknowledge
(PRINT FULL NAME OF FATHER)
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Father's A
Witnessed by:
Address of Witness: .3 I) F. A S l' H T ~ H S l' R F F. l' S IT T l' F. S ? 0 1 / ? 0 ?, r. ART T S T F., PAl 7 0 1 1
BIRTH FATHER'S PERSONAL DATA
~J A_~
FROM:
~ ~ /1,.,
TO:
/I , I P .11.-
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DEPAuMENTOF
HEALTH
...in pursuit of good health
(724-656-3130)
April 27, 2000
Harold S Irwin, III, Esq
Hitner House Suites 201-202
35 East High St
Carlisle PAl 70 13
RE : Bryan Allen Dunbar
File #: 3093920-98
Dear Mr Irwin:
We have received your request for a certified copy of the above birth record. There is a discrepancy
between your request and the information on the original birth record. To amend the father's name on your
child's birth record, submit a certified copy of a Court Order. An acceptable Court Order is a Support Order or
Custody Order, which specifies paternity, an Aclmowledgment of PaternitylWaiver of Trial, the final ruling by
the court on the blood tests or DNA tests, or a Directive Court Order.
Upon review of the above file, it was discovered that the mother was married at the time of this birth.
The Aclmowledgment of Paternity signed by the parents is not acceptable as it can only be signed for a child
born to an unmarried woman, which is stated at the top of the form. Therefore to establish a father on this record
will require a court order.
If you cannot comply with the above instructions you may contact us at the above telephone
number. If you have previously returned an incorrect certified copy or a $4.00 fee, you will receive an amended
birth record once the correction is completed. Otherwise, you must submit a $4.00 fee, or return any incorrect
copies for free reissue.
Birth Correction Unit
enc.
FA T/nrk
To expedite processing, submit your reply by priority mall obtainable from the post office.
PLEASE RETURN THIS LETTER AND A SELF ADDRESSED STAMPED ENVELOPE WITH YOUR REPLY.
Division of Vital Records
...
P.O. Box 1528
...
New Castle, PA 16103
IN RE: : IN THE COURT OF COMMON PLEAS OF
BRYAN ALLEN LINEBAUGH, : CUMBERLAND COUNTY, PENNSYLVANIA
a minor, : ORPHANS COURT DIVISION
: NO. 01 - CIVIL TERM
CONSENT
I, DONALD E. LINEBAUGH, being over the age of eighteen years, certify the
following:
1. My name is Donald E. Linebaugh.
2. I am 39 years of age (Date of Birth: October 23, 1961).
3. My marital status is "single".
4. At the time of the birth of the child, Bryan Allen Linebaugh, I was
married to but separated from his mother, Kimberly Lynn Linebaugh, now
Kimberly Lynn Capron.
5. Greg Allen Dunbar is the natural father of the child, Bryan Allen
Linebaugh, born to Kimberly Lynn Linebaugh on February 8, 1998.
6. I hereby voluntarily and unconditionally consent to the amendment
of the child's birth record to change his name to Bryan Allen Dunbar and to add
the name of his natural father, Greg Allen Dunbar and request that the Court
enter an order as requested in the petition without the necessity of a court
hearing.
7. I have never assumed any parental responsibilities for this child,
but I understand that by signing this consent I indicate my intent to permanently
..,
I .....
give up any rights to this child which I may have by virtue of having been married
to Kimberly Lynn Linebaugh, now Kimberly Lynn Capron, at the time of the birth
of the child.
8. I have read and understand the above and I am signing it as a free
and voluntary act.
~1 5, 2000
f7J \~
DONALD E. LINEBAUGH /..
SWORN TO AND SUBSCRIBED
BEFORE ME THIS S- DAY
OF MAY, 2000~ <5-; d. 00 0
Cl;;;rn~ifh-
Notary ublic
NOTARIAL SEAL
CHERYL D. SMITH, Notary Public
Mt. Holly Springs Borough, Cumberland Co.
My Commission Expires Feb. 18, 2002
. f
IN RE: : IN THE COURT OF COMMON PLEAS OF
BRYAN ALLEN LINEBAUGH, : CUMBERLAND COUNTY, PENNSYLVANIA
a minor, : ORPHANS COURT DIVISION
: NO. 00 - CIVIL TERM
CONSENT
I, GREG ALLEN DUNBAR, being over the age of eighteen years, certify the
following:
1. My name is Greg Allen Dunbar.
2. I am 39 years of age (Date of Birth: November 14,1961).
3. My marital status is "single".
4. I am the natural father of the child, Bryan Allen Linebaugh, born to
Kimberly Lynn Linebaugh on February 8, 1998.
5. I hereby voluntarily and unconditionally consent to the amendment
of the child's birth record to change his name to Bryan Allen Dunbar and to add
my name as his natural father and request that the Court enter an order as
requested in the petition without the necessity of a court hearing.
6. By acknowledging paternity of the child I recognize that this gives
me all the rights and duties as to the child which I would have had if I had been
married to Kimberly Lynn Capron at the time of the child's birth.
7. I acknowledge that I have read this petition and have been advised
of the alternatives to, the legal consequences of, and the rights, responsibilities
and obligations of acknowledging paternity.
. .
. ' I .
. . ...
8. Having done so, I am signing it as a free and voluntary act.
M8Y _' 2000
A~+ '5>,~CO\
SWORN TO AND SUBS~BED
BEFORE ME THIS \6 DAY
OF MAY, 2888.
A u..Sus t Q1.C:O \
Llllirl~,
Notary Public
NOTARIAL SEAL
WANDA K. SHOWERS, Notary Public
Carlisle, Cumberland County
My Commission Expires July 18, 2006