HomeMy WebLinkAbout09-3233
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY,
PENNSYLVANIA
IN RE:
NAME CHANGE OF File No. 6 et. 3 2 33 C.LJ -c....
SURVIVING SPOUSE
NOTICE TO RESUME PRIOR SURNAME
(PLEASE PRINT OR TYPE)
Notice is hereby given that the above named Petitioner,
fj'C'10- Lel4h S? lrn?n residing at,
'41 d& S 4-ak- S?. Eno 1& F P4 1? 0 a S being a
surviving spouse as of Qa c i u j 2 3 x 0 0.? . hereby intends
to resume and hereafter use the previous name of
T'r t G ?. 4 r' e ?Z. and gives this
written notice avowing his / her intention pursuant to the provisions of 54 Pa.C.S. §
704.1. A Certified copy of the Certificate of Death for the decedent is attached.
Date:
Signature of Petitioner
'-- I I I j(-'y - dtr6
SSignture of At6ne being res ed
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
Z ov?
On the day of , 2W, before me, the Prothonotary or the
notary public, personally appear the above affiant known to me to be the person whose
name is subscribed to the within document and acknowledged that he / she executed the
foregoing for the purpose therein contained.
In Witness Whereof, I have hereunto set my d and official seal.
Notary Public
(Note: This notice mast be accompanied by an original,. clIkPW a WftM d6**N1%WAdit
decedent) NOTARIAL SEAL
.indy Neidlg Killinger, Notary Public
Camp Hill, Cumberland County
Commission Expires April 20, 2010
:i
2009 MAY 2 i A t i,*.5-6
'-/dec. R 7 k. 5J
-70-V 3-V
u,na.9n, VC R°.V. 61^,
This is to certify that this is a true copy of the record which is on file in the Pennsylvania Division of Vital Records in accordance
with Act 66, P.L. 304, approved by the General Assembly, June 29, 1953.
Military
Status
WARNING: It is illegal to duplicate this copy by photostat or photograph.
2 o?
Calvin B. Johnson, M.D., M.P.H. Frank Yeropoli
Secretary of Health State Registrar
1495859
SEP 0 2 2008
Date
No.
HIOLI 11EV 11MM
TYPE I RW W
11144NENT
KArK ba(
xI
COMMONWEALTH OF PENNSYLVANIA.- DEPARTMENT OF HEALTH • VITAL RECORDS
CORONER'S CERTIFICATE OF DEATH
10a h- m nlin aM mrsnanlg a m er 1 STALE FU NUMBER
1. Naa. of 0=8111dPnt nWA W.I V^ 2.aw & aorta a.d.lAlNdlbw 4. Dr. d Dwdi(baddn, ft YW
Marc Jason Stahlman male 193 - 66 - 9755 August23;2008
6.AP(LW%IdAl 1WWI WerI 10,00011M(Mmlk 7. MOM (ft rd.bbd hP1M*0I00 i or
wad. liar r.d.
'
Oct 21, 1973 Oil City PA ?ERIMOW d ?WA 7.M.3 Ndw ?R.I ?oft-
34 Yn.
* ty:
e0.0=*19 DIM a CA2ft%Tap.dDIM 3dFrigNNrpyWV40"420n*adNW"6r) fVdrDac.d"awprlcoddbnT qNo Yw 10.?AedkrYids,ebdtWN.,ab
?
P
7i
? (
Dauphin Harrisburg Harrisburg Hospital
rn
Pwd.?LdoJ
wrr white
11. ftow"n poM ovewden Rd dwnd .r dMa •.. Do asmOe 1ZWn Dawdbdawbh 13 Dendmn; EddadmRpMip ald WghW orp.bA 14. tblM VWK HOOi.0. NMr" 15.S -vap r(Ntla/w nndddi llrW)
rrdddWdb idMa B.idr/bdmy UAA nd Faw.1 /Saaadaly p12) Ddw(1-4 w 5.) Wtlrbd, wand (OWO,
Fork Lift Operator trucking 11y. oft 12 married Tricia Bretz
I&Da"Wo WYgAddar(BNK 041 WW d1b, rip aod.)'
406 State St DaoadNal - -Nd Dacadod
Ad11d R.deNr. 17a BW LMb ina 1n0Wf,D.i de R LAad in Tap.
Enola PA 17025 17b.Daaw Cumberland Taa*.NVT 17cLW
Oft o ?a3ddw" Enola
?
gylBao
tt FMM. Nana (TOK nMrd, bd, adbp
K 1b. NrW. NM F0A.Md.,
w.ibo nwray
=n
Robert Stah Sandy Foy
2DL bdalldnr. Nea1001M I A" 20D. bd.lll.d. MdlioAdddw (aba.Ldyrbal4 dd1., o ca*
i
Tricia Stahlman 406 State St Enola PA 17025
21LM.Iddd VApn1bn KICoO , ?- 21A Oda d oNaWan iMaii,&A rrd 21a PbwddlpodbnobmaoNnr. I ardnardw*o 2W. L"AnPIVI*A ow lip aad.)
.? Bow ? RaMM OMM am Wr emnam or 0dlrm
wwMErw.ro.•r.r•? Y.QNa
Aug 27, 2008
N/W PA Cremator
Clarion PA 16214
F F- lbmw la pasty 8*9 w.Mt 220. Ud.nee B.lbd 2td.Ndw ddAddn.ta Fdr•y
Morrison Funeral Home Inc 110 Petorleum St Oil City PA 16301
b.ad23ad My aM ftk%1 23a Tddn bw al aybod.ta, deeM o m Md h tlw., &ft ad Pima. $We& (%NW IM 0) ft. Ll.aw Ni" 238. D& ftl6d lNdrt dy, ywq
? LrAftowddn.dammin .
aAw crwd4dM
Bar31@6wMr•wp•rd by P• 24. Tbwd D.db 25.D.WRciw 0..d0b.4d.y,y*M AWo Cm R.imadb MwkW Ernbw I Cawwb a Rbwm Ohr Ow Gmaln w Dmdw?
WM paaaiaa dw& 12:55Am. August 23, 2008 1my1t ?No
CAIME OF DEATH (ha blgtedrr and aNarpba) , AppnrOad. bar..t Put R am dw 2& ON Tab• Ur.Oadln. to Dwdi1
11.n27.PMk 6drhd?dlmY-d.wri(ulu,amapfedbir-BMdn*owodN.drADDN7er4vMliW dw4 rich r cudw nna, • or" lob OWl hr rolimiliq inhvlhdjbpa Orrin PadL ? W. ?Ro6.*
Aybabry anM,wvwMairabdr.n aNnldWgh.a.lagt W aryaw err.m..dnin. ? Na ? Udonm,
m?tl i a. Anoxic Brain Injury
m.3Fawl.:
ft
? R
DA to (or r a dovingmanarl: - i
Y
a
v
dbOalany, b. DRIB Overdose ' d pnprl w
IN yw
? Raps alh.ddNA
??
?l
1a
?N?ri?CMl? Du.a(wr•mn•9••1p•d): Q Na PnO+n,br pnpMa ai3dn42d.p.
•,r, ??? J
d ' d d..pi
Dr b (d n a fA0••4M11[a ? Naipnpr., bd pqr. 43 dep to 1 yrr
•
d. • 1088060
? Ud.mm ipngrn wMbhpM ym
30a Wr wOkWopy 304 WNA&M Fhxh 31.1 d DU M 3r. D.1. d pry Abn4 dry, ywp 32p. Drab Hda bbry 0WAW =c. Fb O . IbaN, Bnr, Frbry.
Pdbaa.d7 knubPdorbcao"
ac.raawn QN.aM [] August 12; 2008 Overdose Home
Q Yes ® ND
Q Wa Q No M
29 Acck- ? P04V y dr f-
M. rbr d Y(uy
32a 4q d WoA1 30.2 TlrlryaYddn bpy Am* -
32p.1=dM d V*n *4K dyr koR MIM)
?MMM ?CMdNdb.DftrA d Unknownw ?Yr am i]Dlrw/o.w.t. ?P°°„ pr.srra 406 State Street, Enola, Pa. 17025
oaaa- rte
33a Miff dn.r mN an) 32L q Tdbd OWKAVI?
• CdIwY3 pIry kYl lPby.b+bn ••ntMn2 ewr d dMM aMn ¦dnr pbydd.n Or piainnvad &a and a••4bbd am 23)
Ahbaralwaawl.d3a, data awrad drblit-A.daWd nd•W---------------------------------?
Li- A •CW Do"
• Pl-mahladd.liyW3pby.Mr(Phydcbnbahpmarrigdwdtbdcw"lo==dd..tla
Q 33tUCFW .N.nbw Dd. Sped(NOtrl,dry.YW
Tahbrtrrrrn.bap drn.nannerd.n.. ------------------ August 25, 2008
• w.alBdadar/oaaON
on so b..Ydaiwbr3w andlwbawil30^1mwyeptlon,drl6 adanadrhWw,dra.aM P1.o.. alt dwblln wn.alN wr aaawwrrd.d_ ®
3d. Nrn rd aRaar Wh. Crpbbd CUraDaalh lYm27)lypal PrH
Wteiper
Use A
a6 nd DW.M Nwbq .. /' ._ L 36. Fled (Naga d* ra•6 .
1271 South 28th Street
I .I 117 j dA ?j Hanisbu , PA 17111
`'?- '.. - -pypbaYOn Panrl No.-
... ,ate
IN RE CHANGE OF NAME OF
Mildred Eileen Winn
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
NO.: 4 9- 3; 3j-,
PETITION FOR CHANGE OF NAME
AND NOW, comes the Petitioner, Mildred Eileen Winn, by and through her attorneys,
Melanie L. Erb, Esquire and the Law Offices of Darrell C. Dethlefs, who files this Petition for
Change of Name and avers as follows:
1. Petitioner is Mildred Eileen Winn, an adult individual currently residing at 401
McCormick Street, Enola, Cumberland County, Pennsylvania, 17025.
2. Petitioner has resided at 401 McCormick Street, Enola, Cumberland County,
Pennsylvania, 17025 since January 1, 2003.
3. Petitioner was born on August 20, 1950 Petitioner's name on her birth certificate
is Mildred Eileen Walk.
4. Petitioner was married on April 25, 1970 to Gordon E. Winn and took her
husband's last name, thereby becoming Mildred Eileen Winn.
5. Petitioner has been using Eileen as her first name since she was a child and
wishes to legally change her name to reflect this.
6. Petitioner would therefore legally be known as Eileen Mildred Winn, born Walk.
46
WHEREFORE, Petitioner respectfully requests this Honorable Court enter an Order
granting her Petition for Change of Name.
Respectfully Submitted,
Mel ie 'Erb, Esquire
PA D. No. 84445
The Law Offices of Darrell C. Dethlefs
2132 Market Street
Camp Hill, PA 17011
(717) 975-9446
Attorney for Plaintiff
VERIFICATION
I verify that the statements made in the Complaint are true and correct. I
understand that false statements herein are made subject to the penalties of 18 Pa.C.S.
§ 4904 relating to unworn falsification to authorities.
Date: 0 9
Mildred E. Winn
t f "h ` r'T1',?V
2Ge19 MAY 21 l 11 ? 31
? is. "b po A7rY
aco- Oso
P3* as s w8s
SP 4-198 (11-99)
PENNSYLVANIA STATE POLICE
CENTRAL REPOSITORY
1800 ELMERTON AVENUE
HARRISBURG, PA 17110
717-783-3762
PROTHONOTARY
CUMBERLAND CO COURTHOUSE
1 COURT HOUSE SQUARE
CARLISLE, PA 17013
DATE: Monday, June 15, 2009
RE: SID:
NAME: WINN MILDRED
SOC: 202-42-6898
COURT DOCKET #: 09-3231 CIVIL
In accordance with the Name Change Act of 1998, the fingerprint cards of the above named individual, who
has applied for a name change, has been searched in the files of the Pennsylvania State Police, Criminal Records and
Identification Division Central Repository, and:
X)o This person is not subject to 18 PA C. S. Chapter 91, and the fingerprints have been destroyed.
( ) This person is subject to 18 PA C.S. Chapter 91, and the name change has been noted on the person's
criminal history record information.
( ) A criminal record was revealed containing felony convictions. IN ACCORDANCE WITH THE NAME
CHANGE ACT, THE COURT SHALL NOTIFY THE PENNSYLVANIA STATE POLICE WHEN A NAME
CHANGE FOR A PERSON CONVICTED OF A FELONY HAS BEEN ORDERED. The Pennsylvania State
Police, upon receipt of this notice, shall include the change of name information in the Central Repository as
provided for in 18 PA C.S., Chapter 91 (relating to criminal history record information).
( ) This person has been convicted of felony violation(s) for which the court may not order a change of name.
( ) A criminal record was revealed that might prohibit a name change. Because the subsection(s) of the
affected conviction(s) has not been provided to us, we are unable to determine whether a name change can
or cannot be made. Please provide the subsection(s) of the following crime(s):
if available.
You are also advised that the above response is based on comparison of fingerprints and associated requester-
furnished information against a name index and fingerprints contained in the files of the Pennsylvania State Police
Central Repository - only - and does not preclude the existence of other criminal records which may be obtained in the
repositories of other local, state, or federal criminal justice agencies.
If we may be of any further assistance to you concerning this matter, please contact us at the above address or
telephone number.
Sincer ,
Director, Criminal Records
and Identification Division
2009 Ml 13 PU 10: 0
r
1t. i
IN RE: CHANGE OF IN THE COURT OF COMMON PLEAS OF
NAME OF MILDRED CUMBERLAND COUNTY, PENNSYLVANIA
EILEEN WINN CIVIL ACTION - LAW
NO. 09-3231 CIVIL TERM
ORDER OF COURT
AND NOW, this 23rd day of June, 2009, upon consideration of the attached
Petition for Change of Name, a hearing is scheduled for Thursday, August 20, 2009, at
3:30 p.m., in Courtroom No. 1, 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 the County at least 10 days prior to the
hearing; in addition, Petitioner shall comply with all other requirements of C.C.R.P. 5,
and the Act of December 16, 1982, P.L. 1309, §6 (see 54 Pa. C.S. §701 [Historical and
Statutory Notes] [Main Volume]), and 54 Pa. C.S. §§701 et seq.
BY THE COURT,
th
t
l
J /Wesley 0164 Jr.,
Melanie L. Erb, Esq.
The Law Offices of
Darrell C. Dethlefs
2132 Market Street
Camp Hill, PA 17011
Attorney for Petitioner
6, d3.OY
4--
:rc
FL,_'
9 `¢u{, C J
v''. _ 1 TV
Melanie L. Erb, Esquire
Law Office of Darrell C. Dethlefs
2132 Market Street
Camp Hill, PA 17011
(717)975-9446
merb@dcdlaw.net
Attny. Id. No.: 84445
Attorney for Petitioner
IN RE: CHANGE OF NAME OF IN THE COURT OF COMMON PLEAS OF
Mildred Eileen Winn :CUMBERLAND COUNTY, PENNSYLVANIA
NO.: 2009-3231 CIVIL TERM
PRAECIPE
To the Prothonotary:
Please kindly docket and file the enclosed Proof of Publication of Notice of Name
Change Petition.
Respe~Fy~i Si~Jl~+a,
~Ile~nieYL. Er-brEsquire
Attorney ID No.: 84445
Law Office of Darrell C. Darrell C. Dethlefs
2132 Market Street
Camp Hill, PA 17011
717-975-9446
Attorney for Petitioner
PROOF OF PUBLICATION
State of Pennsylvania, County of Cumberland
Erica Peterson, Classified Manager of The Sentinel, of the County and State aforesaid,
being duly sworn, deposes and says that THE SENTINEL, a newspaper of general
circulation in the Borough of Carlisle, County and State aforesaid, was established
December 13th, 1881, since which date THE SENTINEL has been regularly issued in
said County, and that the printed notice or publication attached hereto is exactly the
same as was printed and published in the regular editions and issues of
THE SENTINEL on the following day(s):
August 1, 2009
COPY OF NOTICE OF PUBLICATION
;~
"e.~ ri~livi~`a k<i«.~.~+i~i
~ riC3~
Affiant further deposes that he/she is not
interested in the subject matter of the
aforesaid notice or advertisement, and that
all allegations in the foregoing statement
as to time, place and character of
publication are true.
and subscribed before me this
~U~IW ~ l~~ ICI i~l'
Notary Public
My commission expires:
vOMMONWEALTH QF P~ YLVANIA
NOTARIAL SEAL Punic
gAM81 ANN HECKENDORN;Notary
Camp MNI Boro., Cumberland County
Comrtussan Ex 'res Janua 27, 2 1 U
~~~~ ~~~/
~" ('i'~V~tllfri
~~ arc t ~ ~~ 3~ ~ 4.
v~ ur'~mr
:+ .
~`C ,~