HomeMy WebLinkAbout11-8365COMMONWEALTH OF PENNSYLVANIA : IN THE COURT OF COMMON PLEAS OF
IN THE MATTER OF PETITION FOR
CHANGE OF NAME OF:
KELLY FONTES HEATH
CUMBERLAND COUNTY, PENNSYLVANIA
DOCKET NO.: 1 1- 3 3t, S ?r 1. t Vi (
DATE FILED:
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PETITION FOR CHANGE OF NAME
Petitioner, requests that this Court order a change of the petitioner's name, pursuant to 54 Pa. Cons.
Stat. Section 701, et seq., and in support thereof makes the following the averments:
1. The petitioner was born on October 25`h, 1977 and is over the age of twenty-one years.
2. During the five years preceding the filing of this petition, the petitioner has resided
In the following places:
DATE ADDRESSES
06/2010 - present 928 Forbes Road, Carlisle, P.A. 17013 - Cumberland County
05/2009 - 05/2010 1416 Bradley Drive, Apt. 213, Carlisle, P.A. 17013 - Cumberland County
05/2006 - 05/2009 1019 Main Street, Apt. E, Millis, M.A. 02054 - Norfolk County
11/2003 - 05/2006 55 Main Street, Apt. 10, Medway, M.A. 02053 - Norfolk County
3. There are no judgments or decrees pending against the petitioner.
4. The Petitioner requests that her name be changed from Kelly Fontes Heath to Kelly Fontes de
Almeida Heath.
5. The reasons for the requested change of name are,
1) I was born in October 25th 1977, and my parents named me KELLY FONTES DE ALMEIDA.
After getting married in this country I adopted my husband's last name "HEATH". However, when
I applied for my documents - green card, driver's license and social security card, my family's
name "DE ALMEIDA" was mistakenly excluded from my name. My husband and I went to Brazil
to legalize our marriage certificate and the Brazilian authorities did not accept this exclusion of my
family's name "DE ALMEIDA". According to them my marriage certificate does not request or
specify such an exclusion of my family's name "DE ALMEIDA". My name in Brazil remains
KELLY FONTES DE ALMEIDA HEATH after marriage, but here in the U.S. my legal documents
state my name as being KELLY FONTES HEATH.
2) At present, I am 27 weeks pregnant and my soon to be child will be entitled to dual citizenship,
inheritance and all the benefits as an American-Brazilian citizen. However, he will be prevented of
all the above in Brazil if I do not correct my name because he cannot have a mother with two
different names in two different countries.
3) For this reason, I kindly request from your HONOR to rule positively in my petition with the
urgency this matter requires before the child is born that my family name "DE ALMEIDA" be
reapplied to my legal name in this country, so my name will be the same in both countries.
WHEREFORE, the petitioner respectfully requests that this Court enter an Order changing her
name from KELLY FONTES HEATH to KELLY FONTES DE ALMEIDA HEATH.
Petitioner
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FBI NO. ELI
ARMED FORCES NO. MNU •. i. H55 __
Number 1267
FEDERATIVE REPUBLIC OF BRAZIL
JOSE ALVE LINHARES
ary Public and Official of the Civil Registry of Natural Persons of the I" District
Freguesia do Engenho Novo of the County of Rio de Janeiro
State of Rio de Janeiro
Substitutes: Antonio Sbano
Euclydes Pereira Cortez
Streets: Joaquim Meier, 66 - Meier
Arquias Cordeiro, 268 - I" floor - Meier
BIRTH
I "fy that on page 84 of book number EE.49 of the registry of births it was written
un term 5156 the one of KELLY FONTES DE ALMEIDA, born on October twenty-
fift Nineteen seventy-seven at 08:40 at Silvestre Adventist Hospital, in this city, female
se aughter of Diniz Fortunato de Almeida and Linete Rocha Fontes de Almeida.
Pat al granddaughter of Benedito Pedroso de Almeida and Isaura Maria de Almeida
and maternal of Jose de Melo Fontes and Adeilaide da Rocha Fontes, that is to say,
Ad( i aide da Rocha Fontes.
The declarer was the father on 11/22/1977 and witnesses were Antonio Pereira Lima
Ju o, that is to say, Antonio Pereira Lima Junior and Renato Carneiro Brandariz.
Ob rvation: registry done in the terms of Law 6015/73 - article 46.
I, "vener under oath issued it.
Th eferred is true and I give it faith.
Rio de Janeiro, November 22nd 1977.
(Signature) illegible
Antonio Sbano
Official and Substitute Notary Public
Reg. 06/566
that I am a competent bilingual translator in the Portuguese and English languages and that
translated this document completely and to the best of my ability and accuracy.
1
ELIANE CANTE O PUTNEY
100 Concord St.
Framingham - MA 01702
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TA G IMA R GIST 1VIL DAS PESSOAS NATURAIS DA 10." CIRCUNSCRI(;AO
G A DO N O NOVO DA COMARCA DO RIO DE JANEIRO
?..?' O DO RIO DE JANEIRO
DR, ANTONIO SBANO
DR, EUCLYDES PEREIRA CORTEZ
JOAQUIM MEIER, 66 - MFIE R
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ARQIIIAS COIZC1L,i!zo 1, 268 - 1. Andar - Meier
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L' NASCIMENTO
CER ICO due as fis. 84 - do livro n.° EE*49 de registro de nascimentos
foi lavrado sob terms 5156 - o de. KELLY FONTES DE AUMDA -
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nascido(a) aosvinte a cinco - de outubro - de mil novecentos a setenta
e Sete -
as 08 huras a 40 minutos, no Hospital Adventis
to Silvestiiz - nesta cidade -- do sexo feminino -
Mho(a) de Fortuna to de .?Imeida -
?T tes de.--. Alma
ida -
neto pat,rmo de anedito Pedroso de i :Weida a Isaura Maria de fL -.ieida -
e materno de osa de blelo Fontes a Adeilaide da Rocha Fontes -digo$ Adelaide
da Rocha F es -
foi declarants ZZ / 11 /1977 . o Pi -
e serviram de t stemunhas Antonio Pereira Lima Junirotdigot Antonio Pereira Lima
Junior a to Carneiro Brandariz -
Observagoes g1stro feito nos termos da Lei 6015/73- art 46 -
ROglitt ir;i Tabeliao
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WEALTH OF PENNSYLVANIA
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EXPIRATION E CLASSES ENDORSEMENTS
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KELLY FONTES HEATH
928 FORBES RD
CARLISLE PA 17013
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Card Exoires 11115120
Resident Since: 11/20/08
COMMONWEALTH OF PENNSYLVANIA
Kelly Fontes Heath,
Petitioner,
IN THE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY, PENNSYLVANIA
: DOCKET NO.: J i - ? S& S ei V
: DATE FILED:
-03
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PETITION TO PROCEED IN FORMA PAUPERIS
I hereby request that I be permitted to proceed in forma pauperis. In support of this I state the
following:
1. I am the Petitioner in the above matter and because of my financial condition I am unable to pay the
fees and costs of the proceeding.
2. I am unable to obtain funds from anyone, including my family and associates, to pay the costs.
3. I represent that the information below relating to my ability to pay the fees and costs is true and
correct:
(a) Name: Kelly Fontes Heath
Address: 928 Forbes Road, Carlisle, P.A. 17013
Social Security No.: 014-92-3892
(b) Employment
Employer: N/A
Address: N/A
Salary or wages per month: N/A
Type of work: N/A
%4 I AM PRESENTLY UNEMPLOYED
Date of last employment: N/A
Salary or wages per month: N/A
Type of work: freelancer - nanny, Portuguese translator, etc...
c) Other income within the past twelve months
Business or profession: $ 4.000,00
Other self-employment: N/A
Interest: N/A
Dividends: N/A
Pension and annuities: N/A
Social Security benefits: N/A
Support payments: N/A
Disability payments: N/A
Unemployment compensation and supplemental benefits: N/A
Workman's compensation: N/A
Public, assistance: N/A
Other: N/A
(d) Other contributions to household support
Spouse's Name: Daniel Stephen Heath
Employer: Carlisle Regional Hospital
Salary or wages per month: $ 3.500,00
Type of work: Nurse
Contributions from children: N/A
Contributions from parents: N/A
Other contributions: N/A
(e) Property owned
Cash: $ 0
Checking account: $ 350.00
Savings account: 0
Certificates of deposit: 0
Real estate (including home): 0
Motor vehicle: Make: Year: 0
Cost: $ Amount owed: 0
Stocks; bonds: 0
Other:
(f) Debts and obligations
Mortgage: $ 1,305.45
Rent: $0
Loans: $586.89
Other:0
(g) Persons dependent upon you for support:
Spouse's Name: N/A
Children, if any: N/A
Name Age: N/A
Other persons: N/A
Name Relationship: N/A
4. I understand that I have a continuing obligation to inform the court of improvement in my financial
circumstances which would permit me to pay the costs incurred herein.
5. I verify that the statements made in this affidavit are true and correct. 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: III 01 I 2C) I1 SIGNATURE OF PETITIONER: t d
IN THE MATTER OF IN THE COURT OF COMMON PLEAS OF
PETITION FOR CHANGE CUMBERLAND COUNTY, PENNSYLVANIA
OF NAME OF
KELLY FONTES HEATH CIVIL ACTION - LAW
2011-8365 CIVIL TERM
ORDER OF COURT
AND NOW, this 11th day of January, 2012, after
hearing, the within petition for change of name is granted,
and it is ordered and directed that the petitioner, Kelly
Fontes Heath, shall be hereafter known as Kelly Fontes
de Almeida Heath.
By the Court,
n Hess, P. J.
Ms. Kelly Fontes de Almeida Heath
928 Forbes Road
Carlisle PA 17013 `iaJ ebb
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