HomeMy WebLinkAbout10-2096IN THE COURT OF COMMON PLEAS OF Cumberland COUNTY, PENNSYLVANIA
CIVIL DIVISION -LAW
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IN THE MATTER OF
PETITION FOR CHANGE OF NAME OF
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Tina Dare Brinkley ; NO; T,
PETITION FOR CHANGE OF NAMEc ern
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Ti
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na
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ey, requests that this Court order a change o e
Petitioner
petitioner's name, pursuant to 54 Pa. Cons. Stat. Section 701, gf egg;., and in support thereof
makes the following the averments:
1. The petitioner was bom on
06/14/1974
and is currently 35
years old.
2. During the five years preceding the filing of this petition, the petitioner has resided
in the following places:
DATE ADDRESSES
10/01/2004 - Present 43 Gale Road, Camp Hill, Pennsylvania 17011
3. There are no judgments or decrees pending against the petitioner.
4. The Petitioner requests that his/her name be changed from Tina Dare Brinkley to
Teena Dare Brinkley
5. The reasons for the requested change of name are
1 am already known by Ibis name in my profession and would like to be known by my professional name in
my personal and business affairs.
6. The Petitioner has not been convicted of a felony.
WHEREFORE, the petitioner respectfully requests that this Court enter an Order
changing his/her name from Tina Dare Brinkley to Teena Dare Brinkley
Petitioner
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VERIFICATION
1, Tina Dare Brinkley , verify that the statements made in the
foregoing Petition are true and correct to the best of my knowledge or information and
belief. I understand that this verification is made subject to the penalties of 18 Pa.C.S.
§ 4904 relating to unsworn fabrication to authorities, which provides that if I knowingly
make false averments, I may be subject to criminal penalties.
Date: I ? a4 - 10
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(Sign Your Current Narr6f
IN THE COURT OF COMMON PLEAS OF Cumberland COUNTY, PENNSYLVANIA
CIVIL DIVISION -LAW
IN THE MATTER OF
PETITION FOR CHANGE OF NAME OF
Tina Dare Brinkley NO:
ORDER
AND NOW, this day of , 20_, upon the motion of the petitioner, it is
ORDERED that a hearing on the Petition for Change of Name is fixed for
20 at _.m., in Room of Cumberland County Courthouse,
Carlisle
Pennsylvania.
The petitioner is directed to give notice of the filing of the petition and of the date of the
hearing by publication in two newspapers of general circulation in this County, one of which
may be the official paper for the publication of legal notices in this county.
By the Court:
Presiding Judge