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IN THE COURT OF COMMON PLEAS OF = "
CUMBERLAND COUNTY, PENNSYLVANIA ?-+
IN RE: DARRELL DOUGLAS No. for 2010
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NAME CHANGE
PETITION FOR CHANGE OF NAME -7 AL
AND NOW, this _L- day of January, 2010, comes Petitioner, Darrell Douglas, and files the
following Petition, and in support thereof, avers the following:
1. Petitioner, Darrell Douglas, is an adult individual residing at 12308 Tideswell Mill
Court, Woodbridge, Virginia 22192.
2. Petitioner was bom on January 12, 1967, in Cooke County, Illinois.
3. Petitioner is on active duty with the United States Army and his domicile is 533 Craig
Road, Carlisle, Cumberland County, Pennsylvania.
4. Petitioner desires to change his name from Darrell Douglas to Darrell Cordell
Duckworth.
5. Petitioner is seeking a change of name for the following reasons:
a. Petitioner's mother's last name is Duckworth and Petitioner has used the last
name Duckworth since birth. Petitioner is known as Darrell Duckworth with the United States
Army, the Department of Defense, and the Social Security Administration.
6. Petitioner does not wish to change his name for any illegal purpose, to avoid the
payment of taxes or other debts, or to avoid any obligation. Petitioner has been fingerprinted and his
fingerprint card is attached hereto as Exhibit "A" and by reference incorporated herein.
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7. Petitioner's counsel has searched the index in the Prothonotary's Office in the Court
of Common Pleas of Cumberland County and there are no judgments against Darrell Douglas.
WHEREFORE, Petitioner, Darrell Douglas, respectfully requests this Honorable Court to
issue an Order changing his name from Darrell Douglas to Darrell Cordell Duckworth.
Respectfully submitted,
LAW OFFICE OF SEAN M. SHULTZ, P.C.
Sean M. Shultz, Esquire
Attorney ID No. 90946
4 Irvine Row
Carlisle, Pennsylvania 17013
(717) 701-8412
Attorney for Petitioner
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
IN RE: DARRELL DOUGLAS No. 3,31 for 2009
NAME CHANGE
VERIFICATION
I VERIFY that the statements set forth in the attached Petition are true and correct to the best
of my knowledge, information and belief. 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: 1 l-- I u to
6 Darrell Douglas
Exhibit "A"
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: Thursday, January 14, 2010
RE: SID:
NAME: DOUGLAS DARRELL
SOC: 425-31-5640
COURT DOCKET #: 237-2010
In accordance with the Name Change Act of 1998, the fingerprint cards of the above named individual ho
,
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has applied for a name change, has been searched in the files of the Pennsylvania State Police, Criminal Reek _and t-
Identification Division Central Repository, and:
1)O This person is not subject to 18 PA C. S. Chapter 91, and the fingerprints have been destroyed. - ` r
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( ) This person is subject to 18 PA C.S. Chapter 91, and the name change has been noted on the person's 1
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criminal history record information. j
O A criminal record was revealed containing felony convictions. IN ACCORDANCE WITH THE NAMES 1
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.
Sincerely,
4c?
Director, Criminal Records
and Identification Division
t
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
IN RE: DARRELL DOUGLAS
No. a,37 for 2010
NAME CHANGE
JAN 212010
ORDER OF COURT
AND NOW, this day of V"?,010, upon consideration of Petitioner's Petition
for Change of Name, it is ORDERED that a hearing on Petitioner's request be held on
I &AJ, /.5, 2010, at 3. W 1, •, in Courtroom No. 3, Cumberland County
Courthouse, Carlisle, Pennsylvania.
IT IS FURTHER ORDERED that the notice of the filing of said Petition and the aforesaid
date, time and place of the hearing be published once in the Cumberland County Law Journal and a
newspaper of general circulation in the County at least ten (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, Section 6, and 54 Pa. C.S. Section 701 et seq. (1995 Supp.).
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IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
IN RE: DARRELL DOUGLAS
To Prothonotary:
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PRAECIPE
Pursuant to the Order of Court dated January 22, 2010, attached please find copies of the
Proofs of Publication of the publication of the Notice of Hearing in the above-captioned matter. The
Notice was published in the Cumberland Law Journal on February 5, 2010, and in The Sentinel on
January 29, 2010.
Respectfully submitted,
Date: March `4 '2010
LAW OFFICE OF SEAN M. SHULTZ, P.C.
Sean M. Shultz, Esquire
Attorney ID No. 90946
4 Irvine Row
Carlisle, Pennsylvania 17013
(717) 701-8412
Attorney for Petitioner
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PROOF OF PUBLICATION OF NOTICE
IN CUMBERLAND LAW JOURNAL
(Under Act No. 587, approved May 16, 1929), P. L.1784
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
ss.
Lisa Marie Coyne, Esquire, Editor of the Cumberland Law Journal, of the County and
State aforesaid, being duly sworn, according to law, deposes and says that the Cumberland Law
Journal, a legal periodical published in the Borough of Carlisle in the County and State aforesaid,
was established January 2, 1952, and designated by the local courts as the official legal
periodical for the publication of all legal notices, and has, since January 2, 1952, been regularly
issued weekly in the said County, and that the printed notice or publication attached hereto is
exactly the same as was printed in the regular editions and issues of the said Cumberland Law
Journal on the following dates,
Viz
February 5, 2010
Affiant further deposes that he is authorized to verify this statement by the Cumberland
Law Journal, a legal periodical of general circulation, and that he is not interested in the subject
matter of the aforesaid notice or advertisement, and that all allegations in the foregoing
statements as to time, place and character of publication are true.
,,?Asa Marie Co , Editor
SWORN TO AND SUBSCRIBED before me this
5 day of February, 2010
Notary
NOTARIAL SEAL
DEBORAH A COLLINS
Notary Public
CARLISLE BORO, CUMBERLAND COUNTY
My Commission Expires Apr 28, 2010
CUMBERLAND LAW JOURNAL
NOTICE
NOTICE IS HEREBY GIVEN that
on January 7, 2010, the Petition of
Darrell Douglas was filed in the Court
of Common Pleas of Cumberland
County, Pennsylvania, praying for
a decree to change his name from
Darrell Douglas to Darrell Cordell
Duckworth.
The Court has affixed March 15,
2010, at 3:00 p.m. in Courtroom No.
3 of the Cumberland County Court-
house as the time and place for the
hearing of said Petition, when and
where all persons interested may
appear and show cause, if any they
have, why the prayer of said Petition
should not be granted.
SEAN M. SHULTZ, ESQUIRE
LAW OFFICE OF
SEAN M. SHULTZ, P.C.
Attorneys for Petitioner
4 Irvine Row
Carlisle, PA 17013
(717) 701-8412
Feb. 5
PROOF OF PUBLICATION
State of Pennsylvania, County of Cumberland
Tames Kleinklaus Director of Sales and Marketi ng, 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):
Tanuary 29, 2010
COPY OF NOTICE OF PUBLICATION
NOTICE
NOTICE IS HEREBY GIVEN that on the 7th day Of January, 2010, the Petition
of OARRELL DOUGLAS was Mad fn the Court of Common Pleas of
Cumberland County, Pennsylvania, praying for a decree to change his
name from Darrell Douglas to Darrell Cordell Duckworth,
The Court has affixed the 15th day of March, 2010, at 3:00 p.m. ip Courtroom
No. 3 of the Cumberlah County Courthouse as the time and place for the
hearing of said Petition, when and where all persons interested may appear
and show cause, if any they have, why the prayer of said Petition should not
be granted.
Sr Shultz, Esquire
LAW OFFICE OF'S1N M. SHULTZ, P.C.
4 Irvine Row
Carlisle; Pennsylvania 17013
(117) 701-8412
Attorney for Petitioner
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
.br 2010
Notary Public
My commission expires:
COMMONWEALTH OF PENNSYLVANIA
NOTARIAL SEAL
TAMMY S. BRICKNER, Notary Public
Cadisle 0oru., Cumberland County
My Comrrtissiun Expires May 13, 2010
Sworn to and subscribed before me this