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HomeMy WebLinkAbout11-0102Name: V t) :U A N1 G- C-) r", ,-, - - c (Name(s) of Parent(s) of Minor Child Who Wants to Change Child's Name) ` CD rJO _ ? Address: 11 SLAPBOALF_ OR I VE f D (Address of Person Who Wants to Change His/Her Name) - C!1 ? +J City: CA M P i LL , PA Zip: 170 11 Phone: 717) -521 2 . I Email: V't,rY1,u, CAY1'L 0 0 dr-11W c_n : N RE: NAME CHANGE OF : IN THE COURT OF COMMON PLEAS C+mk,6-J, COUNTY, PENNSYLVANIA TR f?N Cs V La (NAME OF PARENT(S) : NO. I L- 10 a (2,; vil ?M TUhN TRoNCs V t I (NAME OF MINOR CHILD) PETITION FOR CHANGE OF NAME TO THE HONORABLE JUDGES OF SAID COURT: The Petition of T k & N ,- V (Name of Parent(s) of Minor Child) represents: 1. Minor Child is T V AN T.RON CZ V lJ , who (Name of Person Who Wants to Change His/Her Name) resides at 12 SCAp,SVA I.f OQ [ VF- , (AMp N-( 1 _I PA 17011 (Complete Address of Person Who Wants to Ch nge His/Her Name) 2. Minor Child's date of birth is: of f 1 O 111.0() J4 (Minor Child's Date o Birth) 3. Minor Child has resided at the following addresses for the five (5) years previous to the filing of this Petition: -7:;n S J.-Th S+ , 4A VD is Aoj2 (r PA 1`7tt f (Complete Addresses of all Places Person Who Wants to Change His/Her'Name has Resided for the Past Five (5) Years) 19- SCA QS D A LIE 02 I V E TAM P N i 1(,TA 1701 Revised 10-10 ©CumId&n,1County Court of Common Pleas 44a. o0 P4 ptF' CASH p,t a5= S 4. Minor Child desires and intends to change his/her name to: TO AN vAN Dieu (What is the Name that the Person Wants the Court to Change His/Her Name To) 5. Please state the names and addresses of the minor child's mother and father: (List the Name and Address of the Child's Mother and Father) 7011 H,E_P VAN pafu ; U Iti Oekp-`(? r flA9- ?S8Uk6r--r PA 17111 6. Petitioner or Minor Child provides the following reasons for this request: (State In Detail Why You Want to Change Your Name) 0 CLC?.t'1r L (2-nG?,--L?, S1 I'1a.mo 7. The proposed change in Minor Child's name, if granted, will not be detrimental to the interests of any other person and is not against public interest. 8. The Petition is not filed to defraud creditors. 9. WHEREFORE, Petitioner on Behalf of Minor Child requests the Court, pursuant to the Act of December 16, 1982, P.L. 1309, No. 295 § 2, 54 Pa.C.S. § 701, for the following: a. to fix a hearing on this Petition; b. to direct that notice be given on this Petition and hearing; and Revised 10-10 ©kv,kxt,,JCounty Court of Common Pleas C. to enter a decree changing the Minor Child's name from TU N 'Mnt\l a V[ 1 to TH A N V A N C I E t.? (Complete Present Name) (Complete Proposed New Name) ':]!:] n M,,- \/,A, SIGNATURE F PETITIONER aANG- VV Print Name of Petitioner Revised 10-10 ©Cwy&hG-ACounty Court of Common Pleas VERIFICATION I/we, _ "r(Z A N Cr \/ ti , verify that the facts (Name of Parent(s) of Minor Child) set forth in the PETITION FOR CHANGE OF NAME are true and correct to the best of my/our knowledge, information and belief. I/we understand that the statements herein are made subject to the penalties of 18 Pa.C.S. § 4904 relating to unsworn falsification to authorities. I/ ? /)--oil Date Signature 6f Petitioner nAN(T VU Print Name of Petitioner Revised 10-10 CCur4-&&Arounty Court of Common Pleas IN RE: CHANGE OF NAME OF IRA NCB VU (PARENT(S) NAME) TI JA N VON & \10 (NAME OF MINOR CHILD) : IN THE COURT OF COMMON PLEAS &nA, COUNTY, PENNSYLVANIA : NO: DECREE FOR CHANGE OF NAME AND NOW, this day of 20 , following a hearing on before this Court, and it having been determined that the requirements of 54 Pa.C.S.A. § 701 have been satisfied, it is hereby ORDERED and DECREED that the name of the Minor Child, TO A N T2 ON ?- U l ) is hereby changed to Taw VAN -?l F t 1 and that Minor Child, from this date forward, shall exclusively use and be known by the name of BY THE COURT: DISTRIBUTION: Petitioner's Name and'Address JUDGE I PA 170(1 Revised 10-10 ©Ctt Xounty Court of Common Pleas