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Home My WebLink About04-24-09IN RE: : IN THE COURT OF COMMON PLEAS OF KARON MALIK CONNER, A MINOR :CUMBERLAND COUNTY, PENNSYLVANIA ORPHAN'S COURT DIV~ION h~ . _> NO. ~ :, ~. ~ ~Gt c~c~ ~ 4r, _, ~~, ,- ~ , ::a _, ,--? ~ .~ PETITION FOR APPOINTMENT OF ~ - ~ ;~ ~' __=' GUARDIANS_FOR A MINOR ,- ` ~~ ~' r AND CORRECTION OF BIRTH CERTIFICATE . ~::~ ,. ~~;, The petitioners, ANDREW M. MARTIN and EMMA A. MARTIN, by and through their attorneys, Irwin & McKnight, P.C., respectfully represent the following: 1. Petitioners Andrew M. Martin and Emma A. Martin are adult individuals residing at 9015 Molly Pitcher Highway, Shippensburg, Cumberland County, Pennsylvania 17257. 2. The minor child is Karon Malik Conner, born August 2, 2007, and currently age one (1). 3. This Orphan's Court has exclusive jurisdiction over the appointment of guardians for the minor pursuant to ZO Pa.C.S.A. §711(6), and over the correction and modification of the minor's birth record pursuant to 20 Pa.C.S.A. §711(9). 4. The mother of the minor child is Kalina Cherise Conner, an adult individual of Philadelphia, Pennsylvania, whose current whereabouts are unknown. S. The identity of the father of the minor child is unknown, and upon information and belief the natural mother also does not know the identity of the natural father. 6. Therefore, to the best of Petitioners' knowledge, information, and belief, the only living next-of--kin of the minor child are as follows: a. Kalina Cherise Conner (mother) Present address and whereabouts are unknown 7. Petitioners are members of the Mennonite Caretakers, a charitable program that voluntarily assists mothers who are either incarcerated or face incarceration, by caring for the children of those mothers until their release from prison. 8. Petitioners have been members of the program for almost four (4) years, and during that time have temporarily cared for approximately five different children, including the minor child that is the subject of this Petition. 9. The natural mother was incarcerated at the Riverside Correctional Facility in Philadelphia, Pennsylvania at the time of the birth of the minor child. 10. The minor child was born at Northeastern Hospital in Philadelphia on August 2, 2007, and because of the child's prematurity and the mother's drug dependency, the minor child was transferred several hours after birth to Thomas Jefferson University Hospital in Philadelphia. 11. As a result of the medical concerns regarding the minor child, he remained at Thomas Jefferson University Hospital for approximately eight (8) days. True and correct copies of the admission summary from Thomas Jefferson University Hospital and the newborn identification form are attached hereto and incorporated herein as Exhibit "A." 12. Through the Mennonite Caretakers program, the natural mother agreed to transfer custody of the minor child to Petitioners, and signed an agreement to confirm her consent. A 2 true and correct copy of the Custody Agreement signed by the natural mother on or about August 3~, 2007, in favor of Petitioners is attached hereto and incorporated herein as Exhibit "B." 13. Petitioners provided their address and telephone number to the natural mother and included that information on Exhibit "B," the Custody Agreement signed by the natural mother 14. As a result of the Custody Agreement signed by natural mother and Petitioners, the minor child was released from Thomas Jefferson University Hospital into the care and custody of the Petitioners on or about August 11, 2007. 15. In accordance with paragraph one (1) of the Custody Agreement attached as Exhibit "B," the natural mother granted temporary legal custody of the minor child to Petitioners, specifically including the right to make medical decisions and other decisions important in the life of the child. 16. In accordance with paragraph two (2) of the Custody Agreement attached as Exhibit "B," the natural mother also granted temporary physical custody of the minor child to Petitioners until such time as mother was released from prison and ready to care for the minor child. 17. In accordance with paragraphs three (3) and four (4) of the Custody Agreement attached as Exhibit "B," the parties agreed that the natural mother would continue to have medical updates, photographs, and visitation with the minor child. 18. Petitioners in fact brought the minor child for a visit to the mother's prison on August 29, 2007. A true and correct copy of a photograph taken by Petitioners of the natural mother and minor child during the visit in August 2007 is attached hereto and incorporated herein as Exhibit "C." 3 19. In accordance with paragraph six (6) of the Custody Agreement attached as Exhibit "B," the natural mother further agreed that Petitioners could file for custody or obtain further Order of Court in the event that natural mother is released from prison and fails to obtain or resume custody of the minor child. 20. Following her release from prison, natural mother ceased all contact and correspondence with Petitioners, and all other hospital personnel, prison official, and other social workers known to Petitioners. 21. Petitioners and the minor child had returned to the Riverside Correctional Facility on or about September 18, 2007, in order to visit again with the natural mother. 22. It was during that return visit that Petitioners were informed that the natural mother had been released from Riverside Correctional Facility just several days prior on September 6, 2007. 23. The natural mother never informed Petitioners of her release, and never contacted them after her release either by telephone, letter, or other means of communication. 24. The natural mother also did not provide prison officials with a forwarding address, telephone number, or other contact information. 25. Despite numerous efforts to locate and contact the natural mother, Petitioners have not been able to reach, speak with, or otherwise contact the natural mother. 26. In accordance with the terms of the Custody Agreement attached as Exhibit "B," Petitioners therefore seek temporary appointment as Guardians of the minor child. 4 27. There is no interest of the Petitioners that is adverse to that of the minor child, no e:state in which the minor is interested, and no interest of the minor in which Petitioners are fiduciaries, sureties, or employees of any such fiduciary or surety. 28. The religious persuasion of the natural mother is unknown, and that of the Petitioners is Mennonite. 29. There is presently no estate or assets of the minor child, and such estate or assets are currently anticipated. 30. No other petition has been filed for the appointment of a guardian for the minor child in this or any other jurisdiction. 31. Upon information and belief, the minor child is not the child of a veteran and therefore no notice is proposed to be given to the United States Veteran Administration. 32. However, because of the very young age of the minor child and the unlikelihood that the natural mother can be located, they further seek authority as Guardians of the person of the minor child to transfer physical custody of the minor child to a younger Mennonite couple living in Maryland. 33. Petitioners currently already have six (6) children of their own, the youngest of which is thirteen (13) years of age, and believe they are unable to permanently care for the minor child until he reaches the age of majority. 34. Petitioners therefore seek authority to transfer physical custody of the minor child to the following Mennonite husband and wife: a. Matthew E. Torkelson and Jewel K. Torkelson 11981 Simpsons Mill Road Keymar, MD 21757 5 35. Petitioners further request that this Honorable Court grant them authority to transfer custody of the minor child to Mr. and Mrs. Torkelson in Maryland in order to facilitate possible future adoption proceedings in that foreign jurisdiction. 36. Finally, Petitioners also seek correction of the birth certificate of the minor child. 37. Upon information and belief, the natural mother incorrectly completed the hospital forms and wrote her own name down on the form where the child's name was to be written. 38. Accordingly, the Pennsylvania Department of Health, Vital Records, has the :minor child's recorded name listed as Kalina Cherise Conner, the same as the natural mother's name. A true and correct copy of the minor child's Birth Certificate containing the incorrect name is attached hereto and incorporated herein as Exhibit "D." 39. Petitioners request that the minor child's name be changed on the Birth Certificate from his mother's name, KALINA CHERISE CONNER, to the name his mother intended to give him at his birth as well as the name by which he is known, KARON MALIK CONNER. 40. The requested relief will assist to protect the minor child from the legal, psychological, and emotional confusion that may result from the child and mother having the exact same names. 41. Petitioners request that this Court waive the requirement for official searches of the proper offices of the county wherein the minor child resides on the grounds that the subject of this petition is a minor and that there are no judgments, decrees, or any other like character of record against the minor child. 6 42. The best interests and permanent welfare of the child requires that the Court grant the Petitioners' requests as set forth above. WHEREFORE, Petitioners respectfully request that this Honorable Court: a. Enter a decree granting guardianship of the minor child to Petitioners along with the corresponding temporary legal and physical custody of the minor child in accordance with the Custody Agreement signed by the natural mother and attached hereto as Exhibit "B"; b. In the alternative, fix a date for hearing this Petition and direct that notice of this Petition be given to the natural mother by publication in Philadelphia, Pennsylania, the last known location of the natural mother c. Enter a decree granting Petitioners the authority to transfer physical custody of the minor child to Matthew E. Torkelson and Jewel K. Torkelson in Maryland in order to facilitate possible future adoption proceedings in that foreign jurisdiction; and d. Enter a decree changing the name of the minor child on his Birth Certificate from KALINA CHERISE CONNER to KARON MALIK CONNER. Respectfully Submitted, IRWIN & McKNIGHT, P.C. Douglas .Miller, Esquire Supreme Court I.D. No. 83776 60 West Pomfret Street Carlisle, PA 17013 (717) 249-2353 :Date: Apri124, 2009 Attorney for Petitioners 7 VERIFICATION The foregoing document is based upon information which has been gathered by our counsel and ourselves in the preparation of this action. We have read the statements made in this document and they are true and correct to the best of our knowledge, information and belief. We understand that false statements herein made are subject to the penalties of 18 Pa.C.S.A. Section 4904, relating to unsworn falsification to authorities. ANDREW M. MARTIN EMMA A. MARTIN Date: 4/24/09 Thomas Jefferson University Hospital Conner, Babyboy (Boy) Je~erson Health System® Med Rec ID: 03515549 Admission ID: 38043270 I IIIIII VIII VIII IIIH Illilll VIII II IIIIII VIII VIII Iill VIII IIII Admh Date 008/021 007 * 2 7 0 0 N S 7 0 6 (:ONNER MA 03515549 NURSE PRACTITIONERS INTERIM SUMMARY PAGE 1 OF 4 O8/11/Z007 NAME: Conner, Babyboy (Boy) ADMISSION ID: 38043270 ADMITTED: 8/2/2007 MED REC ID: 03515549 PREPARED: 8/11/2007 PREGNANCY & LABOR MATERNAL AGE: 32 years. G/P: G8 P3 T3 Pro Ab4 LC3. PRENATAL LABS: BLOOD TYPE: O pos. SYPHILIS SCREEN: Negative. HEPATITIS B SCREEN: Not done. HIV SCREEN: Not done. RUBELLA SCREEN: Positive. GBS CULTURE: Not done. OTHER LABS: Hep C +. ESTIMATED GESTATION BY OB: 35 weeks 0 days. PRENATAL CARE: Yes. PREGNANCY COMPLICATIONS: Drug abuse and drug dependency. PREGNANCY MEDICATIONS: Methadone. LABOR: Spontaneous. TOCOLYSIS: None. BIRTH HOSPITAL: Northeastern Hospital. LABOR & DELIVERY COMPLICATIONS: Premature onset of labor and premature rupture of membranes. BIRTH DATE: 8/2/2007 TIME: 02:16 hours WEIGHT: 1.905kg LENGTH: 45.7cm GEST AGE: 35 weeks 0 days GROWTH: AGA RUPTURE OF MEMBRANES: 7 hours. AMNIOTIC FLUID: Clear. PRESENTATION: Vertex. DELIVERY: Vaginal delivery. SITE: In the delivery room. APGARS: 8 at 1 minute, 9 at 5 minutes. CONDITION AT DELIVERY: Pink and active. TREATMENT AT DELIVERY: Stimulation, oxygen and oral suctioning. 'T'RANSPORT I personally transported this infant without incident. In transport for 2 hours.. ADMISSION ADMISSION DATE: 8/2/2007 TIME: 04:53 hours ADMISSION TYPE: Transport. REFERRING HOSPITAL: Northeastern Hospital. FOLLOW-UP PHYSICIAN: Dr. Steinhour, M.D. ADMISSION INDICATIONS: Prematurity, possible sepsis and hypoglycemia. I saw the patient and reviewed the notes and plans. I was available to provide direct personal supervision when the service was provided. ADMISSION PHYSICAL EXAM WEIGHT: 1.905kg LENGTH:47.Ocm HC: 29.Ocm BED: Isolette. HR: 132. RR: 32. BP: Stable. GLUCOSE SCREENING: 56. HEENT: AF soft. Normal faces.. RESPIRATORY: Clear and equal breath sounds.. CARDIAC: RRR no murmer, normal pulses.. ABDOMEN: Soft, 3 vessel cord, no HSM. No tenderness.. GU: Normal preterm male features. CONNER MA 03515549 NURSE PRACTITIONERS INTERIM SUMMARY PAGE 1 OF 4 08!11/2007 Thomas Jefferson University Hospital Conner, Babyboy (Boy) Jegerson Health Syrtem® Med ReC ID: 03515549 Admission ID: 38043270 I IIIIII (!III IIIII IIIII IIIIIII IIIII II IINI{ {!III IIIII !III {!III !III Ad "~ DDate 008/02/2007 * 2 7 0 0 N S 7 0 6 CONNER MA 03515549 NURSE PRACTITIONERS INTERIM SUMMARY PAGE 2 OF 4 08/11/2007 NEUROLOGIC: Active, alert, symmetric movement.. SPINE: No fractures or abnormalities. EXTREMITIES: Normal, hips normal. SKIN: Clear, no lesions.. ADMISSION LABORATORY STUDIES 8/2/2007 11:OOh: WBC:10.3X10*3 Hgb:17.6 Hct:49.1 P1t:250X10*3 WBC: ADJUSTED FOR NUCLEATED RBC'S 8/2!2007 11:OOh:S:57 L:31 M:11 Eo:l 8/2/2007 19:14h:S:63 B:1 L:18 M:17 Eo:l 8/2/2007 19:14h: WBC:9.3X10*3 Hgb:19.8 Hct:53.5 P1t:228X10*3 WBC: ADJUSTED FOR NUCLEATED RBC'S 8/2/2007 11:OOh: Ca:10.2 8/2/2007 19:14h: Na:136 K:5.6 C1:103 C02:23.0 BUN:13 Creat:0.9 Gluc:114 Ca:10.0 Sodium: FINGERSTICK; Potassium: SLIGHT HEMOLYSIS. RESULTS MAY BE AFFECTED.; Calcium: SLIGHT HEMOLYSIS. RESULTS MAY BE AFFECTED. 8/2/2007 19:14h: TBili:3.1 DBili:0.4 Total Bili: SLIGHT HEMOLYSIS. RESULTS MAY }:JE AFFECTED. RESOLVED DIAGNOSES SUSPECTED SEPSIS ONSET: 8/2/2007 RESOLVED: 8/4/2007 COMMENTS: Awaiting 48 hour negative culture. NEONATAL ABSTINENCE SYNDROME ONSET: 8/2/2007 RESOLVED: 8/9/2007 COMMENTS: No signs of withdrawal NAS scores D/C'd yesterday. MATERNAL DRUG ABUSE ONSET: 8/2/2007 RESOLVED: 8/11/2007 COMMENTS: Social service consult requested. MATERNAL INCARCERATION ONSET:8l2/2007 RESOLVED: 8/11/2007 COMMENTS: No follow up of duration. HYPOGLYCEMIA ONSET: 8/2/2007 RESOLVED: 8/3/2007 ACTIVE DIAGNOSES MATERNAL HEP C ONSET: 8!2/2007 STATUS: Active PLANS: Follow clinically and Hepatitis Cfollow-up 6 months outpatient. PREMATURITY - 28-37 WEEKS ONSET: 8/2/2007 STATUS: Active ` COMMENTS: Thermoregulation and feeding progressing well. PLANS: Follow clinically, hearing screen, car seat test and peds f/u 1 week outpatient. ('ONNER MA 03515549 NURSE PRACTITIONERS INTERIM SUMMARY PAGE 2 OF 4 08!11!2007 Thomas Jefferson University Hospital Conner, Babyboy (Boy) Je~'erson Health System® Med Rec ID: 03515549 Admission ID: 38043270 I IIIIII IIIIi VIII VIII IIIIIII VIII II IIIIII VIII VIII (III VIII IIII as hit Date 008/02/2007 * 2 7 0 0 N S 7 0 6 CONNER MA 03515549 NURSE PRACTITIONERS INTERIM SUMMARY PAGE 3 OF 4 08/11/2007 NUTRITIONAL SUPPORT ONSET: 8/5/2007 STATUS: Active COMMENTS: On full feeds with 22 cal formula tolerating ad lib demand. PLANS: Continue same. SUMMARY INFORMATION NEWBORN SCREENING: Last study on 8/7/2007: Results pending. NEWBORN SUPPLEMENTAL SCREENING: Last study on 8/7/2007: Results pending. HEARING SCREENING: Last study on 8/11/2007: Passed Bilaterally. CAR SEAT SCREENING: Last study on 8/11/2007: Normal. PEAK BILIRUBIN: 4.9/0.5 on 8!4/2007. PHOTOTHERAPY DAYS: 0. LAST HEMATOCRIT: 54 on 8/2/2007. IMMUNIZATIONS & PROPHYLAXES IMMUNIZATIONS & PROPHYLAXES: Hbig on 8/2/2007 and Hepatitis B on 8/2(2007. RESPIRATORY SUPPORT Room air from 8/2/2007 until 8/11/2007 NUTRITIONAL SUPPORT IV fluids only from 8/2/2007 until 8/3/2007 TPN and feeds from 8/3/2007 until 8/5/2007 Oral feeds from 8/5/2007 until 8/11/2007 CURRENT PHYSICAL EXAM WEIGHT: 1.868kg LENGTH:45.Ocm HC: 30.3cm BED: Crib. TEMP: 36.9. HR: 170. RR: 41. BP: 71/35. URINE OUTPUT: X6. STOOL: Xl. HEENT: AF soft., normocephalic, palate intact ,red reflex bilaterally and no eye discharge. RESPIRATORY: Clear and equal breath sounds.. CARDIAC: Normal sinus rhythm, strong and equal pulses, good perfusion and no murmur. ABDOMEN: Soft and nondistended abdomen and good bowel sounds bilaterally. GU: Normal preterm male features and uncircumcised. NEUROLOGIC: Active, alert, symmetric movement.. SPINE: No abnormalities. EXTREMITIES: Normal. SKIN: Clear, no lesions.. DISCHARGE & FOLLOW-UP DISCHARGE TYPE: Foster care. FOLLOW-UP PHYSICIAN: Dr. Steinhour, M.D. PROBLEMS AT DISCHARGE: Nutritional support; Maternal hep c; prematurity - 28-37 weeks. RESPIRATORY SUPPORT: Room air. FEEDINGS: PO ad lib. MEDICATIONS: None. EQUIPMENT: None. OUTPATIENT APPOINTMENTS: Foster mother to make appointment no later than 1 week CONNER MA 03515549 NURSE PRACTITIONERS INTERIM SUMMARY PAGE 3 OF 4 08/11/2007 ' Thomas. Jefferson University Hospital Connee°, Babyboy (Boy) O ~e, j~erson Health System° Med RAC ID: 0351.5549 Admission ID: 38043270 I IIIIII VIII VIII VIII IIIIIII VIII II IIIIII VIII VIII IIII VIII IIII Adm" tDDate 008/02?2007 * 2 7 0 0 N S 7 0 6 CONNER MA 03515549 NURSE PRACTITIONERS INTERIM SUMMARY PAGE 4 OF 4 08/11/2007 after discharge. Infant stable today and tolerating all feedings by mouth. Infant has not demonstrated any signs of NAS. Discharge planning done and foster care arranged. DIAGNOSES DURING THIS HOSPITALIZATION 9 day old 35 week premature AGA male newborn Suspected sepsis Neonatal Abstinence Syndrome Maternal drug abuse Maternal incarceration Maternal hep c Prematurity - 28-37 weeks Hypoglycemia Nutritional support Attending MD: Kevin Dysart, MD Printed: 8/ 11 /2007 11:12h CONNER MA 03515549 NURSE PRACTITIONERS INTERIM SUMMARY PAGE 4 OF 4 08!11/2007 • • -~aovaat97 Y of ~:~~ lar~toa7 oa lt:,k~~ irF'r:111 ~ _'. Z tC! .i.t$EaT ~~ :-°'~3~Q7 NEVIrBORN IllENTIFICA'1'ION a a w ~' ~_ s.~ w 0 z ., Q ~~ a ~. H MOTHER.-Name Hospital No. INFAN-r-Na Haspitat No, Ytinted Number in [dent-A-Hand Signature, Person App Idcnt-A-fSand ~ Infant' Birth ~ ate Timc ~ Scx (v(~ ~3 ( a- J 7 c~~ ~ ~ l~- Signa[urcr, Person Taking Prints Color or Race Wright Length r /~- ~['' ~ ~~V ~ }f I INFANT'S LEFT FOOTPRI INi~AIVT'S RIGHT FOOTPRIN-I' (oc palmprint>~ (or palmpdnU .~ ~, a MOTHER'S RIGHT INDEX Signatutrs, P onfirntinR Srx and Identification FINGERPRINT Physician Deliv~ocyrt Nuese // ~ / Nursery,Nutse ,y. , _ _ , ._ ~ :,~,,;:, ~ ~t / " ' >- ~!i ~ , ~~~' UPON DISCHARGE -Affix Infant's I dent-A-Bander bracelet below and j, have statement signed and witnessed. Date I CERTIFY that during the discharge procedure I received my baby, examined it and determined that it was mine. I checked the Ident-A-Band® parts sealed on the baby and on me and found that they were identically numbered and contained correct identifying information. Witness J-lt-~7~ 4 8 7? :13 SS~b t5 GC?8~~2a7 P ,I< 1 ~ 13 e L 0~ 172 1'37 Signed Hospital Reptrsentativc Form A5826-66'I Printed in USA. Mother Hollister HolUster Incorporated Libertyville, Illinois 60048 .~- I~ t4,Ci`RE~~ ~iL•t~1T, nine the ,,,~ Zsy cr ~ ~~ ' M, ~F, VI~,~R~ between ~~ ~ i~ j?~~~rfirr~c., rod~rredt w ss ^~, . „p_. *,w Au*t'~ X11 ~ ~ ~ harer,~bx t'O~tl~ 1~3 iS ~"~ ~I~Q~ ~U~.t1F ~ thG Nlttaaet Mother Of 1110 fo)ib~vittg chtW{znnjc ~~, 1?A'~ d~ gIRT'S~ t{~SBEA.~, ieretalce~ asie Mlodusr v~Avtl t~eaohod en n~ ra3ative io ttre~ era ~ custodi+ rftht dtild(rdt}, the ~ ~: whiicit agreanent bob desire to aat ~ 'm the peewt ~ aad ~atod)r Agreoale~at, the oatrhs intandf~ to ba Y b~wtd, aad m cattoiQpratf~om- ut'tba mewed prom ttAd +~t'aRartu WM1tiDYGd b~'dt; •y eg~ce es foil~-~s: 1. i~fether ~8: oes tc give tempptaxy kggi ~dY of her dtild(rm) to Ca~icac.l.e~ii t1~t'1! tifa right m oo~ltttii e~4 sh:•re it1 v: dexis~ivne of impartaoe+s in dae iiflt of a ~ isuiadim~s , nt+dlod. sed ertiaio+n d®eiaioa . ltito~ec specificalir ~'~ ~ give t~retaicer N1a right to melaa medii~ai d~ ~ tIu tle~eiti- arld wel? being o£the crag?. Z. MeW~ aF ~ ~ ~ ~ Pj-:'~ + a>f her chiid(tw~.) to Gsedker, pLclag ~-e ~pdd{rrol in Caretvicer's haor~e u; :sit such lima whm Mager is ncle~od ~ prsat1 aad tbae ~rtks ~mie1J;- ~ that is . oad~r w care ss ~d c of litc s~~. 3. Cfrvmkar :~• tp xeeg svfotha irform~ad of alt triedioal deciaion~s maQe and a~ to ~ 7'lat poaaad ae- the general ha-tllt end aogress of the child tilreugh ?elter~ e~ pl~cmres. A+~otlaar egroes t~ noay Cantask~ of h~ addreea ~ btie~4o~nr. rumixx. 4. NlOdlet` si~:dl !ffirti vi~iia#ion with file cbild(rert} as the pattlee Dl~iiS' e@'ae• S. .Tees w ~ wad bald hat>rtless Cm ue tM eraat oiP art acci~rtadei death, fie, c~ htjuty, to the+ctt>~dr ~rci h rait~e and hold Csrctaka fait. rer ll~mian amt with rgpaoe to aoy hl-~ +wlatch tna~ n4cur to ~ a child. e. ~ ~~~~~ca* ebnlt oolumut w~l i~.irthes mutw~l ag<e o€tho pen~tlee ar Order oi' Cwae. 3Vothing in this agceeiple~ shai ~ peewttt Giasta~cer from Sor aF ubt~ni~ tl oo~t t7t+dar ga~tit~ Cata~ ~ ~ PhY~ '~ ~ e+~rnt that hdottleF ie rc+kared atld 4ii. eo Olfhitt ar of t31t cilild. ~li~~NES;~' t ~ ~~~ ~ ~~AI'~n.~... ws. ~1,c~,, Data. ~•,~~ .t'~1 ~G~-~ D~~ ~ 3 ~ oT ~ ~,,• gofs r?2a~1~ ~~ :~~1~~- ~f~y tee: ~hip~~s~~rrq j pp ~1a.~~ P~to~t~~~~173~~a-~,~~~ _~ ~ ~~9 L C' .~ 1 I~N~ Edward G. Rendeq Governor Calvttt & Jabnsoa, M.IZ, M.P.H., Secretary of Heattb For information on birth/death records: www.health.state.pa.usivitalrecords R'~CEIVED AFS Number: 20080506916 # Copies: of 1 60 W OMFRET sTES~ IMAY 21 2008 Certificate Fee: $0.00 CARLISLE, PA 17013-3216 Total Certificate Fee: $0.00 1RWIN & McKNIGHT vCN Fee: $0.00 I~~I,III~~~III~~~~l,~ll~~ll~~~ll~l,~l~l~~~ll~lll,l,~ll~~l LAW OFFICES Carrier Fee: $o.oo Name: CONNER, KALINA CHERISE Refund: $O.oO Total Fee: $0.00 WARNING; THIS DOCUMENT IS PRINTED ON SECURITY WATERMAgKED PAPER 9 6 0 5 8 5 3 DO NOT ACCEPT WITHOUT VERIFYING THE PRESENCE OF THE WATERMARK... DETACH HERE TEAR AT THIS PERFORATION DETACH HERE