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Home My WebLink About04-37561N RE: PETITION OF MOHAMMAD MAHMOOD KHAN, AN ADULT INDIVIDUAL : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA : : DOCKET NO. . : CIVIL ACTION - LAW : NAME CHANGE PETITION FOR NAME CI-IANGE To The Honorable, the Judges of Said Court: AND NOW, this day of ,2004, comes Petitioner, by his Attorney, Smith B. Gephart, Esquire, and files this Petition for Name Change pursuant to 54 Pa.C.S.A. § 701 et seq., and in support thereof avers the following: 1. Petitioner is MOHAMMAD MAHMOOD KHAN, an adult individual residing at 100 Oakwood Drive, Wormleysburg, Cumberland County, Pennsylvania 17043. 2. Petitioner respectfully requests that this Honorable Court permit him to change his name to MAJOR KHAN. 3. Petitioner avers that he was bom on November 7, 1965, in the District of Nairobi, Republic of Kenya, as evidenced by a copy of his Certificate of Birth, attached as Exhibit A. 4. Petitioner came to the United States in 1969, has been a naturalized citizen since approximately 1972, and is employed by HUR Private Equities, Inc., 330 Madison Avenue, 6t~ Floor, New York, NY 10017. 5. Petitioner was previously employed as Associate Director of Business Development by UBS, 1285 Avenue of the Americas, New York, NY, for eight years. 6. Petitioner's domicile is 100 Oakwood Drive in Wormleysburg, as evidenced by his latest Federal Tax Return, a partial copy of which is attached as Exhibit B. 7. 8. Petitioner is single, having never been married. Petitioner was previously of the Muslim faith, but is no longer a practicing Muslim, and desires to drop his first name of Mohammad. 9. Petitioner desires to retain his birth surname of Khan, but has been known for many years by bis nickname, Major Khan, rather than Mohammad Mahmood Khan, which is difficult to pronounce, 10. Petitioner avers that he takes this action solely for personal reasons stated above, and not for the purpose of avoiding or defrauding any creditor. 11. Petitioner further avers that there are no creditors who would be adversely affected by the Court's approval of this Petition. 12. Petitioner has requested that a lien search be done under the names Mohammad Mahmood Khan and Major Khan in Cumberland County. A copy of the search is attached as Exhibit C. 13. As part of this Petition process, Petitioner had his fingerprints taken, and the fingerprint record is attached as Exhibit D, law. 14. Proper notice of the Name Change Petition will be made as required by WHEREFORE, Petitioner respectfully requests that this Honorable Court grant his Petition for Name Change and permit Petitioner to be known as MAJOR KHAN. Respectfully submitted, Dated: Attorney ID #6864 Killian & Gephart, LLP 218 Pine Street P.O. Box 886 Harrisburg, PA 17108-0886 (717) 232-1851 Attorneys for Petitioner 3 AFFIDAVIT I, Plohammad Plahmood Khan , hereby verify that the statements in the foregoing Petition for Name Change are true and correct to the best of my information, knowledge and belief. I understand that the statements are made subject to the penalties of 18 Pa.C.S. § 4904, relating to the unswom hlsification to authorities. Form 104 L Label k (See 8 instructions E on page 19.) L I~e the rebel. H or type, 1 Filing Status Check on~y Exemptlono mom theft five Uapenderlta, see page 21. Income Attach For,me W-2 U,$. Individual Income Tax Return M, ~AJO]~ KHAN 2003 ,9003. ending lO00AKWOOD DRIVE WOP~MLEYSBURG PA 17043 196-48-4659 I~, ~o, · Importanfl · your SSN($) above, Note. Checking "Yes" wl)l not change your tax or reduce your refund, You Spouse DoYou, ory0urspouselffllingsjointreturn, went$3to~oicthlsfund?' ...... ~' ~ 'Ce, ~ ~? ~ ~.. ~ No d Total number ofe~empUons c)aimed ............................ 7 Wagll~. ~ala Flee, UPs, etc. Art.ch Form(~ W-2 ..................................... 7~ 127,225 ga O~na~ dividend6, Attach Schedule B If required ga 3 / 8 2 8 you (~ee,.p~ 21~wlth yOU Oue t to divorce or - , (see page 21) [ ~ an Ilnel ~ ......... above ~ I ~1 Form(~) 10gg-R 10 Taxable refunds, credits, or offsets Of state and local Income taxes (see page 23) .......... 10 If ta~ wa~ tl A/imony received ................................................. 11 If you dtd not 13e Capital gain or (loss). Afle~ Scneduts O If required. If not required, ceck here ~ ~t a W~, b If box on 13a is ~e~ed, en~r ~st-May 5 ~¢tal gain dis{¢butions ~ 13b ~ 1Sa IRA di~tdbutbn6 ......... ~ 15a b Te~ble amount (8~ AOLLOV~A 16a PensPone end annu~ea ~ 1Sa ~9.8~2 b T~bl8 s~unl (see page 25) 16b net at~, any 18 Farm Income ~ (Io~}. At.ch ScheduJe F payment. Als0, ' ................................. 21 Other Jncome. Li~ ~pe & grot. (e~ p~g9 27) 21 ~justed ~4 IRA dedu~on (see page 29) ~4 ................ ......... 32a Alimonypald b Reclolent'a SSN~ 32a 1,701 -3,000 0 0 130,792 130,792 Tax and 3; Credits 36a neduct~°n 37 for- ~ 3e ePsopl~ who 3B 53 Other 67 58 61 Payments q u~lil,/In~ [-- $$ Refund e9 Amount You Owe Third Party Designee Sign Here Keep a copy for Polo Preparer's ~'s name Use Only Amount from IJrle 34 (adjusted gross Income) ........................... 35 Check_J- I-'} You were ~om before Januar7 2,1939, ~Blir,d.~_ Tetatboxse Itemized dedu~lone (~rom Schedule A) or your standard deduction {~ee left ma~l~) ........ 37 S~btrac Ime37~om ne35 38 118,371 If line 35 i~ 6104 626 or le~e, mut~pt~ ~.d~d b~ta~ ~ hb~r o(~xe~b,,oh~ cra;me~ on ............ T~xaDle in,me. Sub~ }lqe 3g from tine 38. It f~ne 39 le more than ~x~ee page 35). Check Jf any ~x Is ~om: ~ ~ Form(s) 8~14 .... b ~ Form4gT2 .............................................. 41 26,540 Alternative minimum tax (ese page 38) Aflach Form 6251 Add ~l~es ~1 a~ 4Z ......................... ' ....................... ~ 43 26,5~0 ForslgntaxcmdiLA~hFormll161frequired .......... 44 Credit ~r child ;n~ dependent ~re expenses. AU~ch Form 2~4~ 45 Educafi~ cr~. A~ Form 8863 47 Child tax ~ed~ ~see page 40) .......................... Adop[~on credit. A~h Form 88~ 50 :'~'~ Add I~nes 44 ~ro~h 52. These are your to~l credits ............... 53 ~1~ ~uMm~ine ~oml~ne43. f Ina53 8~ore~el~ Ina 43~en er-0- . ................. ~ 54 26,321 Self-employment tax. At~ S~e~ule 8E ...................................... 55 Socta~ secud[y a~ Medicare ~x on ~lp in,me not repo~d to e~pio~r, ...... ::::::::::::::::::::::::::::::: .... Add ~l.ee 54 - ~e, Thee ~3 ~our ~tm ~.x ........................ Fedem~ I~me t~x ~thheld from FO~a W-2 ~nd 109~ 61 2 8, 9 9 2003 eslimete~ tax ~en~ and amount applied from 2002 return e2 · .,,.d ~.o.m, or.m* (mC) e3 ,~,:~ ~:~ Excess Social se~r~/y and t;~ 1 RRTA t~ ~t~e/d (see pa;e 56) ~dl~onal child ~x ~dit. Afl,ch Form 8812 ............ e5 :~:~:~:~ ~ FCa 2,676 ~ d Account number 71 ~ou~ ~ of l~ne Sg you wa~ appfled to your 2OO4 e~tlmated tex ~ 72 ~ount you owe. Subt~ l~ne 68 from llPe aO. Por de~ll~ ~ ~w lo pay s~ page S7 ~ 72 Do you w~nt to a~ow nno~er peraon to discusa rna tatum with the IRS (see pe~ 58)? ~ Yes. Com0iete the fol~0~ng. ~ NO Geller Marzano & co. CPAs, ~.~, ~ 11-2871323 ~ Pe~ Plaza 14 New York 196-48-4659 130,792 IONNI ABSTRACT COMPANY 104 Walnut Street, Harrisburg, PA 17101 Copies: $ SUMMARY SHEET The information contained~rein ~sb~edf ~rein is b ed sol ly uponqan examination of the recorded evidence of title in the making of appropriate searches from the records of kJJ..~n&.l~.l~-[o~x ~ Count, P*nnsylv~ia. ~e premises he.in.er described ~e subject, but may not be limited to, the liens, ~cumbrances md objections to title as ~ovlded herein. This search O~ not CERTI~ title or make representations as to Quall~ of Title, and the Purchasem of this infor~tion agree, by using the lnfor~tlon herein set fo~h that Ilablll~ hereunder of IONNI ABST~CT COMPANY, ~lely in i~ capacl~ as an abstractor, for 1~ negligence, mistak~ or omi~ions is stffictly limited to a sum not to exceed $750.00. N~n-paymentf~rthese~iceandi~f~rmati~npr~v~d~here~nshallnullandv~idtheinf~rmati~nsetf~h. Recorded: . t LIENS MORTGAGE: $ TO Dated: ......... ASSIGNED on FROM: Recorded: TO in Mist/Record Book in Mtg/Record Book Page MORTGAGE: $_ FROM: TO Dated: Recorded: ........ ASSIGNED on TO in Misc./Record Book JUDGMENT: $ ~ VERSUS Entered on WRIT of Execution issued on __ in Mtg/Re¢ord Book Page Page OBJECTIONS to' Searched By: ~Z ~ lmp:$ IN RE: PETITION OF MOHAMMAD MAHMOOD KHAN, AN ADULT INDIVIDUAL IN THE COURT OF COMMON PLEAS OF CUMBERLAND' COUNTY, PENNSYLVANIA DOC~T NO. ,~/q - .X nO~ CIVIL ACTION - LAW NAME CHANGE AND NOW, thi day of 20(}4, upon consideration of the attached Petition for Name Change, it is hereby ORDERED and DECREED that notice shall be given of the filing of the Petition and of the date, time and place of heating scheduled by the Court. Hearing on the Petition shall be held on the ~/?z~iy of ~~ J, 2004, at 3': ~3 0 ,~ ,m. in Courtroom ~ ~ , Cumberland County Courthouse, Carlisle, Pennsylvania. By the Court: IN RE: PETITION OF MOHAMMAD MAHMOOD KHAN, AN ADULT INDIVIDUAL : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA : : DOCKET NO. I)4-3756 : : CIVIL ACTION - LAW : NAME CHANGE AND NOW, this~day of ~ ,2004, upon consideration of the Petition for Name Change filed by Mohammad Mahmood Khan, and following a heating on the Petition before this Court, it is hereby ORDERED and DECREED that the Petitioner's name is changed from Mohammad Mahmood Khan to Major Khan. By the Court: