HomeMy WebLinkAbout12-4345r
Petition for Change of Name of Adult
Commonwealth of Pennsylvania
County of Cumberland
Name of Petitioner. Brianna Marie Petrosky
Court
Docket No. 11- i ? 1 ? ??-?
In re: Change of Name of Adult
From: Brianna Marie Petrosky
To: Brianna Marie Bucher
Petitioner makes the following declaration:
1. Birth Date and Place: Petitioner was bom on June 13, 1994 in Kittanning,
Armstrong County, Pennsylvania. A certified copy of petitioner's birth certificate is
attached to this petition.
2. Birth Name: Petitioner was named Brianna Marie Petrosky at birth, and as of the
date of this petition, the Petitioner has always been known by that name, with the
following exceptions, if any:
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3. Residence: Petitioner resides at 1880 Holly Pike, Carlisle, Pennsylvania 17015
has lived at this address for 6 years.
4. Petitioner's Parents: The father of the Petitioner is named Brian Lee Petrosky,
his residence is unknown.
The mother of the Petitioner is named Chastity Hope Bucher, and she resides at 1880
Holly Pike, Carlisle, Pennsylvania 17015.
5. Reason for Name Change: Petitioner seeks to change his or her name to Brianna
Marie Bucher and offers the following reason(s) for seeking to do so:
Petitioner has had no contact with birth father since 8 months of age and is requesting
to change name to that of her stepfather, whom has raised her since 2 years of age.
That is also the last name of her birth mother and younger sibling.
6. Legal and Creditor Status: Petitioner does not have any outstanding judgments,
has never been convicted of a crime, and is not involved in any pending legal actions.
NOW, THEREFORE, the Petitioner requests that the court order the Petitioner's name
changed as follows:
Fran: Brianna Marie Petrosky
To: Brianna Marie Pe6esky WC CA
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Verification
I, Brianna Marie Petrosky, affirm under penalty of perjury that I am the Petitioner in the
foregoing Petition to Change Name of Adult and that all statements in this Petition are
accurate to the best of knowledge.
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Pe lion s Signature
Date
Ativ IV P;
Petitioner's Add es ,, Line 1
Petitioner's Address, Line 2
Subscribed and sworn to before me on this I I+-?- d
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COMMONWEALTH OF PENNSYLVANW
N to Notarial Seat
Stacey E. Walls, Notary Public
Guilford Twp., Franklin County
My Commission Expires March 18, 2013
Member, Pennsylvania Association of Notaries
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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: Wednesday, July 18, 2012
RE: SID:
NAME: PETROSKY BRIANNA M .RI
SOC:
COURT DOCKET #: 12-434`
In accordance with the Name Change Act of 1998, the fingerprint cards of the above named individual, who
has applied for a name change, has been searched in the files of the Pennsylvania State Police, Criminal Records and
Identification Division Central Repository, and:
( x) This person is not subject to 18 PA C. S. Chapter 91, and the fingerprints have been destroyed.
( ) This person is subject to 18 PA C.S. Chapter 91, and the name change has been noted on the person's
criminal history record information.
( ) A criminal record was revealed containing felony convictions. IN ACCORDANCE WITH THE NAME
CHANGE ACT, THE COURT SHALL NOTIFY THE PENNSYLVANIA STATE POLICE WHEN A NAME
CHANGE FOR A PERSON CONVICTED OF A FELONY HAS 13EEN 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 tiles 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 c(
telephone number.
Sincerely.
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Director. Crimi?
and Identiticatii
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IN RE: NAME CHANGE OF BRIANNA
MARIE PETROSKY
POW- S-%qq
INIM
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY
No. 2012-4345 CIVIL TERM
IN RE: PETITION FOR CHANGE OF NAME
ORDER OF COURT
OF
AND NOW, this 1St day of August 2012, upon consideration of the Petition for
Change of Name, filed by Petitioner, Brianna Marie Petrosky a hearing on the petition is
scheduled for 24 September 2012,at 3:00 p.m. in Courtroom Number 6,
Cumberland County, Carlisle, Pennsylvania.
IT IS FURTHER ORDERED that notice of the filing of said Petition and he
aforesaid date, time, and place of the hearing be published once in the Cumberland
Law Journal and a newspaper of general circulation in the County at least 10 days p for
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, §6 (see 54 Pa. C.S. § 01
[Historical and Statutory Notes] [Main Volume]), and 54 Pa. C.S. §§701 et. seq.
PROOF of compliance with the aforesaid publications shall be filed
record prior to the hearing.
By the Court,
?A
Thomas A. Placey
Distribution List:
?Brianna Marie Petrosky
1880 Holly pike
Carlisle, PA 17013
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