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Home My WebLink About09-7979LESLEY J. BEAM, ESQUIRE ATTORNEY I.D. 91175 KOPE & ASSOCIATES, LLC 395 St. Johns Church Road, Suite 101 Camp Hill, PA 17011 (717) 761-7573 (beam@kopelaw.com Attorney for Petitioner IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA / IN RE: S.K.B. and S.K.B. NO. DQ- JQ'Yq . 1 : CIVIL ACTION PETITION FOR NAME CHANGE 1. Petitioner is Rebekah K. Harbison, the guardian, primary custodian and natural mother of Sarah K. Brockway, a ten-year-old minor who was born on October 17, 1999, and Sophie K. Brockway, an almost seven-year-old minor who was born on November 17, 2002 (hereinafter the "children"). 2. Petitioner desires to change the children's names from Sarah K. Brockway and Sophie K. Brockway, to Sarah K. Harbison and Sophie K. Harbison. 3. The children's natural father was Brian R. Brockway, who died on May 10, 2008. A copy of his Certificate of Death issued by the County of Livingston, Michigan is attached to this Petition as Exhibit "An. 4. There are no judgments or decrees of record or any other matter of like character against the children. 5. Petitioner's reasons for desiring this change of name of her children are as follows: a. The children's natural father passed away from lymphoma after several years of diagnosis on May 10, 2008, which illness caused the children substantial emotional difficulty; b. Petitioner has been remarried to Andrew S. Harbison since August 19, 2009; c. Petitioner is the sole remaining parent of the children, and the children would benefit from sharing Petitioner's married surname; d. Petitioner and the children share their residence with Petitioner's husband, who has the surname of Harbison; e. The children are of the age where they attend school, and Petitioner desires to protect her children from the psychological and emotional confusion which may result from the children and parent having two different surnames; and f. The children have expressed desire to have the same surname as their mother, the Petitioner. Petitioner's eldest child asked Petitioner when she and her sister would get their stepfather's last name so they would "become one family." 6. Currently, the children live with their natural mother, the Petitioner, at 1425 English Drive, Mechanicsburg, Cumberland County, PA 17055. The children and Petitioner also reside with Petitioner's husband, Andrew S. Harbison. 7. The subjects of this petition are both minors, and as such, Petitioner requests that this Court waive the requirement for publication of the notice in two newspapers of general circulation on the grounds that Petitioner does not wish for child predators or the like to have access to the children's name and address. 8. The subjects of this petition are a 10-year-old minor and an almost 7-year-old minor, neither of which has entered into any contracts, been charged with any criminal conduct, or received any judgments of the court. As such, Petitioner requests that this Court waive the requirement for official searches of the proper offices of the county. 9. The natural father of the children is deceased, and as such, Petitioner requests that this Court waive the requirement that notice of the filing of the petition and hearing be given to the non-petitioning parent. WHEREFORE, Petitioner respectfully requests that this Honorable Court fix a hearing on this petition. WHEREFORE, Petitioner further requests that this Court waive the requirement for official searches of the proper offices of the county wherein Petitioner resides on the grounds that the subject of this petition is a minor and Petitioner avers that there are no judgments or decrees of record or any other matter of like character against the child. WHEREFORE, per 54 Pa.C.S. § 701 (a. 1)(3)(iii), Petitioner further requests that this Court waive the requirement for publication of the notice in two newspapers of general circulation on the grounds that the subject of this petition is a minor, and Petitioner does not wish for child predators or the like to have access to the child's name and address. Dated: I I6 20 o 9 7 Ily ubmitted, 3 am, Esq. VERIFICATION I, Rebekah K. Harbison, the Petitioner in this matter, have read the foregoing Petition for Name Change. I verify that my averments in this Petition are true and correct and based upon my personal knowledge. I understand that any false statements herein are made subject to the penalties of 18 Pa.C.S. § 4904 relating to unsworn falsifications to authorities. Dated: A/ ?D? . _2 3 ?'OUNTY OF LIVINGSTON ra"lu rZotm,"l:a STATEOFMICHIGAN DEPARTMENT OF COMMUNITY HEALTH - _ -^ CERTIFICATE OF DEATH STATEFILE NUMBER tel. DECEDENr'S NAME (Ftrn, IfiaYlr, terry 2. DATH OF BIRTH (ue.rA pelt Rwr) 3. SEX T4?DATE OF DEATH /Mredpw Rev) Brian R. Brockway June DWEDF:1VT' 22, 1974 Male a 10, 2008 5. NAME AT AIRTH OR OTHER NAME USED FOR PERSONAL BUSINESS Mddr ARAB rfey) 6e. AGE - W Bid6daY 6b. UIypER 1 YEAR AGE 6c• UNDER I DAY MONTHS DAYS HOURS MUiV1E5 7a. LOCATION OF DEATTH (l wrtew .?terg ,reeo p.nd py yr 7.. 7a yeJ 3 HOSPITAL T1O OR' OTF Cw. P 10N . Hams ry en p a & .r ?yV'l 76. CITY, VILLAGE, OR TOWNS2?OF DEATH 7c. Co f 5HATH i S I- g c ?. z U, St. Joseph Merc Livin stop Hos ital Howell Ila• CURRENT RESIDENCE- eb. COUNTY Livingston STATE -- Sc• LOCALITY fidert rAr Mr tlur feetNbM Frr d.e.rW) tld 877tEEi• AND NUMBER ? ??a ®torras nerroorAU.hyrtACx i R+rd.drAp. lya. YryurwWr/ . - Michigan Li vin st on Marion 6e.23PCODE 9,giRTHP[.ACSX* 3134 W. Schafer Rd. -, SA. Q0" °D') 10. SOCIAL SECURITY NUMBER 11. DECEDFXrS EDUCATION - WW t, a¦ W&W 48169 Howell Michigan done w IM, of **W ompmd d aw d. ra." 369 02 20 1- CaNe.r, 7U,ier, Ai- I.J4e, 71 4 rs. College 12 RACE - N rkew• F14O. lA Y1 df.. R1eek . fYArYe t1w e.m.a?s 13a. ANCES I Y - hN.km cebm MR A*ke Rrwid, y.e..k Ow 13b. HISPANIC ORIGIN 14: WAS DECRD1B47 EVER M rrt'J (Ewrr ad 4er •IPIi1 (fAew r do yryJ it Ane,iew Lila re.a .W M_,,, mle (Y ... AeJ THE U.S. ARMEDFORCES7 White 6'w er .w Polish-German No No 15. USUAL tz"CUPAnON Ow Md of wat 77rtPLMp!nL-Indust OF BUSINESS ORB4O USTRY aie=17. Wldewed; Dirraee li NAME SURVIVING SPOUSE (V-* (,yk,r Tool and Die r Married Rebekah Martin 19. FATHER'S NAME fflFrc AMdit I+W X MOTHER'S NAME 15EPl3RE rJUr MARRIED Ry'ex mlit, )?VI Richard H. Bro a 21a INFORMANTS NAME (lyPrp?e,y 21b. 1JEC> TITION" 70 21e. MAILCynthia, Lusk ING ADDRESS lJ1mr eef Nrdr w Rwe! Rew1r )6aes Cib, n ,rllgt per yy Cry Rebekah K Brockway Wife 3134 W Schafer Rd. Pinckne Michi as 48169 22. MMMOD OF DISC O31T7ryN 23a. PLACE OF DISPOSITION R)o.r gl Cs..y, K .aM R.rf.t, npMhawa, Y awe! 236 LOCATION - Ciy a Villq,, Sane Reawval, (el+oUYl DEPOSITION Cr tion Southern Michi an reaato 24. A ofM - Ann Arbor Michigan I 14ilE 25• L SE NUMBER 26. NAM AND ADDRESS OF FUNERAL FACB,1Ty Shelters Funeral Home 5769 250 N Mill St. Pinckne Michi an 816 2Ta C7iRTIF1ER 7 t1eer! «d,.wy tea ACTUAL 13R PRffi11M» 21b PRONOUNCED yddwr - To a¦ bee-of my ka wboM &mb *=and 4. a _d TIMB OF DRM Ak DEAD ON Zee. TIME PRO1VOllI4CE,p DW r'o' ' DUD ftw. - or e4 =ft ry. tso. Y wT o,waa de.. 7:30 P M . May 10 2008 7:30 M ? Dom at 6. fim do 00 6-41) Md. ewer 29. MEDICAL ML04DM 10. PLACE F DEATH (lkne, Nee}lee, 131. ff HOSPITAi. igerlles t)gedref, • C0NTACrEr17 (1e er lry Nenly Ileaw, Hee,itrl, Ashehww) (8}egfy) Rwwarrq Room DOA (,1}w* CIEREOXATION $'?""RiiidTpk _ No DATE 9IGNE71 pk r/ k E7aLIC$NSB - g Hospital .,. Inpatient 32 T CASE--] 33. NAME 27b. dq of AIMMME n?"m3m W arim THAN wwokow CERTIFIER m.•_Mrd M/*- ?y • Zoo Es . IJ 03-01 ko 34. NAME AND ADDRESS VE CFRrIFTI IG PHYSICIAN Mpr w pf?o 3S . e. RH(1 '3810NATU!!E ` _ _ 3 ? 5 36. PART of eveata - Awasm IA.1a, or -oeplle,tlam - 0110111011 the &wk DO NDT sate ke'Lel -taut weh o eardhe raded « ? MeeoRl a6uVOy Ek1.'-fiolop Eder dRly m d Em dtaeeaw •' Y • Ono and Dd6D ==b y be een . L----?•+-?. A- ,? BNwr rat l DUE TO (OR AS A COMMMMNM 1 CAUSX Ott Z "= DUTB b. DAMMe I e, CAUSE MW DUR TO MR AS A ODNSEQUNCE OF) rredtle, L A.rk) dMY RR eamlwaee, C. I n' Am, Irret ee tlw eaw:. DUE TO (OR AS A OON Ul'NBf.YIlAN aRQURFK80F) AU 6 w d in du*) LArr ? 3Ii DID 7-cf- PAII IL onaSt embibud , to 8y,h bet serf ee W ft ra dw 4n1a1y1aS Cart prm in PaR L ? Na Ise,neat wi"ie ,eat yew 41jL 3e. m FmdAI,D: El N- ? A a rim. r ere" 39MANN6R OF DFATH - Aaeideq EdNdr, H-aiide 40e 40b W®lS AUTOPSY PENBKIS AV? N« a1°OYR wiOL a2 deyd er dem Padlos a 16) PRIOR TD IBrbN OF CNatural f'r DJIAT'1T( (dt"" t 4I 4W, a ? yew No ? Uekoewe iT PRAftm wRMe 1he,.w yew DAIS OF INJURY 41b. TB? Or INJURY 41c. DHSCRW HOW IWURY OCCURRED MICAL Of.. D W T J ' Mn M ... RXAMBVEN 41d• INIM AT WORK 41a PLACE OF INJURY - At hmw. 41L W TRANSFORTATION M c (ft e. A6J dem W. enwoodw /,Re. INJURY - DdWMPftUn, 6 LOCAI?1. 9am1 or RPD No. t Iy. YALp orTwp. Sim _ w,-odeA yue,r. yeam,h., rte, (-Peen,) DM-OW 1603 14-37444 \ I, MARGARET M. DUNLEAVY, CLERK OF SAID COUNTY OF LIVINGSTON DO HEREBY CERTIFY pF Mj?, that the foregoing is a true and exact copy of the original document on file in my office. A7e M D DATED: MAY 12 2008 `?? 0 1 WANGMN CDLiNTY CLERK u.:. r't7t?a?Y t J F, •l ? E i r ?4 v"a so IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA IN RE: E.M.J. NO. Q y _ 779 C!v -?e(.,ti : CIVIL ACTION ORDER OF COURT FIXING HEARING AND NOW, this b " day of y 2009, upon consideration of the attached Petition for Name Change filed by the Petitioner: 1. A hearing on the Petition of Rebekah K. Harbison, for change of name is fixed for J , 2A at q o'clockr-\- m, at C4• PA.. ??f,?-?- CO• 2. The Petitioner is not directed to give notice of the hearing by publication in two newspapers of general circulation in Cumberland County, Pennsylvania, one of which publications may be the official paper for the publication of legal notices in that county. 3. The Court hereby waives the requirement for official searches of the proper offices of the county. 4. As the non-petitioning parent is deceased, the Court hereby waives the requirement that Petitioner give notice of the hearing to any non-petitioning parent of the children whose names are affected by the proceedings. BY THE COURT, By: J. KE F AUVMTARY 2089 NOV 18 PM 3= 2 8 ? i? s"-)OU Yi 1 ?K- It PENN5YiVANLA 10 a/c f , °I? t (? ? i P~Ot-riCE 2Q40J~'~ -8 A~9 9~ t ~ ~'~ ; ai`vj ~ LVr~~`'.~ IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA IN RE: S.K.B. and S.K.B. NO. ~~~. 7S'7,~' ~~~ CIVIL ACTION ORDER OF COURT CHANGING NAME ~4 -0 AND NOW, this ~~ day of ~w~- „~G399'; upon consideration of the attached petition and after hearing, it is found as a fact that the requirements of 54 Pa.C.S. § 701 have been satisfied and the names of the minor children are hereby changed from Sarah K. Brockway and Sophie K. Brockway to Sarah K. Harbison and Sophie K. Harbison. BY THE COURT, By: J.