HomeMy WebLinkAbout12-52234
IN RE CHANGE OF NAME OF
T rique C. Via, a minor,
b Leanne M. Via, parent
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
NO.. ] ,?- SvZa 3 CA 0
: Civil Action - Name Change Petition
PETITION FOR CHANGE OF NAME
AND NOW, comes the Petitioner, Leanne M. Via, by and through her attorneys, Michael
J. Pykoshj, Esquire and the Dethlefs-Pykosh Law Group, LLC, who files this Petition for Change
of Name and avers as follows:
1.' Petitioner is Tarique C. Via, a minor, by Leanne M. Via, parent, currently residing
at 939 Allendale Road, Mechanicsburg, Cumberland County, Pennsylvania, 17055.
2.Petitioner has resided at 939 Allendale Road, Mechanicsburg, Cumberland
County, Pennsylvania, 17055 since on or about September, 2004.
3.'Petitioner previously resided at 106 Millers Lane, Harrisburg, PA, since
approxinjately June 1995 through September 2004.
3. Petitioner was born on June 3, 1995, whereas Petitioner's name on his birth
certificate was Tarique Supreme Shabazz.
On June 14, 2000, pursuant to a Court Order Docketed at 1736 S 2000 Dauphin
County (a copy of which is hereto attached and made a part hereof and marked Exhibit "A"),
Petitioner's name was legally changed to Tarique C. Via.
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5. As a result of the aforementioned June 14, 2000, Court Order, Petitioner's birth
certificate was changed to reflect his name as Tarique C. Via. An original birth certificate is
attached hereto and marked Exhibit "B".
6. Petitioner has been using Terance Clyde Via as his name since he was three (3)
years old land wishes to legally change his name accordingly.
7. Petitioner would therefore legally be known as Terance Clyde Via.
8. Petitioner's father was Supreme A. Shabazz in accordance with Section six (6) of
the Divorce Settlement Agreement dated June 30, 1998. Petitioner's father surrendered physical
and legal (custody of Tarique to his mother Leanne M. Via. A copy of said Settlement Agreement
is attached hereto and marked Exhibit "C".
9. Petitioner's father is deceased having passed away on April 17, 2010.
WHEREFORE, Petitioner respectfully requests this Honorable Court enter an Order
granting this Petition for Change of Name.
Respectfully Submitted,
f.
Michael J. Pykosh, Esquire
ID #58851
Dethlefs-Pykosh Law Group, LLC
2132 Market Street
Camp Hill, PA 17011
(717) 975-9446
Attorney for Petitioner
VERIFICATION
I verify that the statements made in the Complaint are true and correct. I
understand that false statements herein are made subject to the penalties of 18 Pa.C.S.
§ 4904 relating to unsworn falsification to authorities.
Date;±?§ JJ' O `?--
Tariqu . i , a minor, by
Leann . VA, parent
IN RE:
IN THE COURT OF COMMON
PLEAS OF DAUPHIN COUNTY,
PENNSYLVANIA
TARIQUE SUPREME SHABAZZ,
a minor,
by L:,]ANNE M. VIA, parent. NO. 1736 S 2000
CIVIL ACTION - LAW
NAME CHANGE PETITION
DECREE
AND NOW, this 'day of LIM
2000, upon hearing of the within Petition and upon motio by GARY L. MARTIN,
attorney for Petitioner, and upon presentation of proof of publication of notice as
required by Order of this Court, and it appearing that there is no legal objection to the
ranting 4f the prayer of the Petition,
IT IS ORDERED AND DECREED that `he name of the petitioner be and is
hereby changed to TARIQUE C. VIA.
BY THE COURT:
J.
JUN 14 28
herei y girlie ! Thai the foregoing is a
true and correct cc'y of the original
filed.
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Prothonotary
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SEPARATION AGREEMENT
DIVORCE SETTLEMENT AGREEMENT
CUSTODY AGREEMENT
T?iis agreement is made on c - , 1998, by and
between, LEANNE M. VIA, resi i?g at 106 Millers Lane, Harrisburg, Dauphin
County, Pennsylvania, and, SUPR A. SHABAZZ, a/k/a LARRY A. JOHNSON,
f/k,/a LE M. SETTLE, who resides at the Municipal Detention Center - Brooklyn, 100
29th Street, Brooklyn, N. Y.
THE PARTIES STIPULATE AND RECITE THAT:
A.I! They are husband and wife, having been married on the 8th day of August,
1994, in Hagerstown, Maryland.
B.'The parties have one (1) child; Tarique Shabazz who was born on June 3,
1995.
C.,Leanne M. Via has resided in Pennsylvania for at least six months prior to
the date) of this agreement. Supreme A. Shabazz agrees that Dauphin County,
Pennsylvania is the appropriate court of jurisdiction for this matter.
D. Supreme A. Shabazz is presently serving a sentence of 14 years in federal
prison for numerous felony convictions for drug dealing and weapons offenses.
Supreme'A. Shabazz agrees and admits that because of his felony convictions and
criminal history, he is unfit as a parent of the minor child.
E.' ii parties agree that their marriage is irretrievably broken. As a
consequence, the parties have separated as of December 15, 1995 and are now living
separate nd apart at their respective residences shown above. The parties desire to
fully and finally settle their respective financial and property rights and obligations as
between each other, including without limitation by specification: the settling of all
matter b?tween them relating to the ownership and equitable distribution of real and
personal property; settling of all matters between them relating to the past, present
and future support, alimony and or maintenance of the children; the implementation
of custody for the minor child of the parties; and in general, the settling of any and all
claims by one against the other or against their respective estates. This separation
agreement shall form the basis of the parties' divorce.
NOW THEREFORE, in consideration to the mutual promises, covenants and
undert*ngs hereinafter set forth and for other good and valuable consideration
receipt o which is hereby acknowledged by each of the parties hereto, each intending
to be legallly bound hereby, covenant and agree as follows:
F ? I Exy?rr?
SECTION ONE
DIVORCE
A. The parties hereby acknowledge that Leanne M. Via has filed a Complaint
in Divorce in Dauphin County at Docket Number 2099 S 1998, claiming that the
marriage is irretrievably broken under the no-fault mutual consent provision of Section
3301 (c)' of the Pennsylvania Divorce Code, and/or under the two (2) year separation
provisions of Section 3301 (d) of the Pennsylvania Divorce Code. Supreme A. Shabazz
hereby expresses his agreement that the marriage is irretrievably broken and expresses
his intent to execute any and all affidavits or other documents necessary for the
parties to obtain an absolute divorce pursuant to Section 3301(c) or (d) of the Divorce
Code. It 0 further specifically understood and agreed by the parties that the provisions
of this Agreement relating to equitable distribution of property of the parties are
accepted by each party as a final settlement for all purposes whatsoever, as
contemplated by the Pennsylvania Divorce Code.
BJ Should a decree, judgment or other order of separation, divorce, custody,
visitation or support be obtained by either of the parties in this or any other state,
country IPr jurisdiction, each of the parties hereby consents and agrees that this
Agreement and all of its covenants shall not be affected in any way by any such
separation, divorce, custody, visitation or support order; and that nothing in any such
decree, judgment, order or further modification or revision thereof shall alter, amend
or vary ony term of this Agreement, whether or not either or both of the parties shall
remarry.'' It is specifically agreed, that a copy of this Agreement or the substance of
the provisions thereof, may be incorporated by reference into any divorce judgment or
decree or other order or decree of court. It is the specific intent of the parties to
permit this Agreement to survive any judgment and to be forever binding and
conclusive upon the parties.
SECTION TWO
LIVING SEPARATE
A. !,It is agreed that both parties, at all times hereafter, will live separate and
apart at such residences as they each may choose, wholly free from marital control,
authority, advice, and influence, as if they were each sole and unmarried.
B. Each party shall be free from interference, authority, and contact by the
other, as fully as if he or she were single and unmarried, except as may be necessary
to carry out the provisions of this Agreement. Neither party will in any manner molest
or annoy the other, or compel or endeavor to compel the other to cohabitate or dwell
with him'', or her, by any legal proceedings for the restoration of conjugal rights, or
otherwisel, Neither party will call upon or visit the other without the full consent and
approval of the other. Neither party will in any way harass or malign the other, nor
in any way interfere with the peaceful existence, separate and apart from the other,
Page 2 of 11
C. Both parties may continue in their respective occupation, or engage in such
other different occupations as they may each desire, free from the control or
interference of the other. Except as provided herein, each party will receive and retain
their respective income from their occupations.
D!, The foregoing provisions shall not be taken as an admission on the part of
either party of the lawfulness of the causes leading to their living apart.
SECTION THREE
PROPERTY DIVISION
Ai The parties hereto have divided between themselves, to their mutual
satisfaction, all items of tangible and intangible personal and real property. Neither
party shjall make any claim to any such items of marital property, or the separate
personal property of either patty, which are now in the possession and/or under the
control Of the other. Should it become necessary, the parties each agree to sign, upon
request, any titles or documents necessary, to give effect to this section. Property shall
be deed to be in the possession or under the control of either party if, in the case
of tangible personal property, the item.is physically in the possession or control of the
party at the time of the signing of this Agreement, and in the case of intangible
personal property, if any physical or written evidence of ownership, such as passbook,
checkbook, policy or certificate of insurance or other similar writing is in the
possession or control of the party. The parties hereto shall be deemed to be solely and
individuol ly in the possession, control and ownership of any pension or other employee
benefit pans or other employee benefits of any nature to which either party may have
a vested or contingent right or interest at the time of the signing of this Agreement.
B.'', Each of the parties shall hereafter own and enjoy, independently of any
claims or right of the other, all items of personal property, tangible or intangible,
hereafte acquired by him or her, with full power in him or her to dispose of the same
as fully nd effectively, in all respects and for all purposes, as though he or she were
unmarried.
SECTION FOUR
RELEASE OF PROPERTY AND ESTATE RIGHTS
EAch party hereby waives, relinquishes, and releases:
A. All right and claim in or to the property of the other, including all rights of
dower, ctirtesy, and marital share;
B. 'All right to share in the estate of the other under the laws of succession of
the Commonwealth of Pennsylvania or any other state, wherein either party may
hereafterl,be domiciled or own property;
Page 3 of 11
C. All right to object to or interfere with the last will and testament of either
party, including any and all rights, privledges or claims of Supreme A. Shabazz to
object to or interfere with Leanne M. Via establishment of guardianship of the minor
child by will or otherwise as contemplated by the provisions of this agreement relating
to custody of such child; and
D.! The right to serve as executor or administrator of the estate of the other
party, orl, to take under the last will and testament of the other party, except by will,
or codicil to a will, hereafter made.
SECTION FIVE
DEBTS AND OBLIGATIONS
A. j The parties hereto agree that they have no joint debt. Neither party shall be
liable foie the individual debt of the other party.
B.', Each party represents that they have not heretofore incurred or contracted
for any other debt or liability or obligation for which the estate of the other party may
be responsible or liable except as may be provided for in this Agreement. Each party
agrees to? indemnify and hold the other party harmless for and against any and all such
debts, lialbilities or obligations of every kind which may have heretofore been incurred
by them,) including those for necessities, except for the obligation arising out of this
Agreement.
C. The parties covenant, warrant, represent and agree that with the exception
of obligations set forth in this Agreement, neither of them shall hereafter incur any
liability whatsoever for which the estate of the other may be liable. Each party shall
inde=4 and hold harmless the other party for and against any and all debts, charges
and liabilities incurred by the other after the execution date of this Agreement, except
as may be otherwise specifically provided for by the terms of this Agreement.
SECTION SIX
CUSTODY OF MINOR CHILD
A. '!Supreme A. Shabazz agrees and consents that Leanne M. Via shall have sole
physical 4nd legal custody of the minor child. Supreme A. Shabazz hereby terminates
and relinquishes any and all rights, privileges or claims of custody, partial or split
custody, and/or visitation with Tarique Shabazz.
B. Supreme A. Shabazz understands and agrees that this agreement to
terminate and relinquish all rights, privledges and claims of custody, partial or split
custody, and/or visitation is irrevocable.
Page 4 of 11
C. Supreme A. Shabazz understands that Leanne M. Via may re-marry in the
future and that her new husband may wish to adopt Tarique Shabazz as his son. As
provided'' by the Pennsylvania Adoption Act, Supreme A. Shabazz:
1) Hereby voluntarily and unconditionally consents to the adoption of the
above named child;
2) Hereby understands that by signing this consent, Supreme A. Shabazz
indicates his intent to permanently give up all rights to this child;
3) Hereby understands that Supreme A. Shabazz may not revoke this
consent after a court has entered a decree confirming this consent or
otherwise terminating his parental rights to this child. Even if a decree
has not been entered terminating my parental rights, I may not revoke
this consent after a decree if adoption of this child is entered.
4) Hereby acknowledges that I have read and understand the above and
that I am signing it as a free and voluntary act.
D.', Supreme A. Shabazz hereby agrees and consents to a change in the name of
his son, Tarique Shabazz, to Tarique Via using his mother's maiden name, or, such
other naijne which conforms to the surname of Leanne M. Via's subsequent husband,
whether or not it is part of a legal adoption of the child.
E. Both parties agree that should Leanne M. Via die or become incapacitated
before thle majority of the minor child, Tarique Shabazz, custody and guardianship of
the minor child shall be determined by the last will and testament, or other written
document, of Leanne M. Via. Supreme A. Shabazz waives, relinquishes and forever
terminates any and all rights, privledges or claims to appoint a guardian or otherwise
assert custody of the minor child.
SECTION SEVEN
CHILD SUPPORT
Leanne M. Via agrees to release, relinquish and terminate any and all rights,
privileges or claims for support of the minor child.
SECTION EIGHT
ALIMONY OR MARITAL SUPPORT
Each party hereby waives, releases and gives up any rights they may
respectively have against the other for alimony, spousal support or maintenance. It
shall be, from the execution of this Agreement, the sole responsibility of each of the
respective parties to sustain themselves without seeking any support from the other
party.
Page 5 of 11
SECTION NINE
FULL DISCLOSURE
Each party asserts that she or he has made a full and complete disclosure of all
the real and personal property of whatsoever nature and wheresoever located
belongi4g in any way to each of them, of all debts and encumbrances incurred in any
manner, hatsoever by each of them, of all sources and amounts of income received or
receivable by each party, and of every other fact relating in any way to the subject
matter of this Agreement. These disclosures are part of the consideration made by
each party for entering into this Agreement.
SECTION TEN
ATTORNEY'S FEES AND COSTS
Leanne M. Via agrees to pay for the costs and attorney's fees for the divorce and
the preparation of this agreement. It is agreed that Supreme A. Shabazz shall pay
Leanne ?M. Via's costs, and attorney's fees, with legal interest, to defend, enforce or
implement the terms of this agreement.
SECTION ELEVEN
DATE OF EXECUTION
Tle "date of execution" or" execution date" of this agreement shall be defined as
the data upon which it is executed by the parties if they have each executed the
agreement on the same date. Otherwise the "date of execution" or "execution date" of
this agreement shall be defined as the date of execution by the party last executing
this agreement.
SECTION TWELVE
DISTRIBUTION DATE
The transfer of property, funds and/or documents provided for herein, shall only
take place on the "distribution date" which shall be defined as the date of execution of
this agreement or as otherwise specified herein.
SECTION THIRTEEN
MUTUAL RELEASE
The parties hereto each do hereby mutually remise, release, quitclaim and
forever discharge the other and the estate of such other, for all time to come, and for
all purposes whatsoever, of and from any and all rights, title and interests, or claims
in or against the property (including income and gain from property hereafter
accruing) of the other or against the estate of such other, of whatever nature and
wheresoever situation, which he or she now has or at any time hereafter may have
Page 6 of 11
against the other, the estate of such other or any part thereof, whether arising out of
any former acts, contracts, engagements or liabilities of such other or by way of dower
or curtesy, or claims in the nature of dower or curtesy or widow's or widower's rights,
family exemption or similar allowance, or under the intestate laws, or the right to take
against the spouse's will; or the right to treat a lifetime conveyance by the other as
testamentary, or all other rights of a surviving spouse to participate in a deceased
spouse's ''estate, whether arising under the laws of (a) Pennsylvania, (b) any State,
Commonjwealth or territory of the United States, or (c) any country, or any rights
which either party may have or at anytime hereafter shall have for past, present or
future support or maintenance, alimony, alimony pendente lite, counsel fees, property
division, '',costs or expenses, whether arising as a result of the marital relations or
otherwise, except, all rights and agreement and obligations of whatsoever nature
arising or which may arise under this Agreement or for the breach of any provisions
thereof. It is the intention of the parties hereto to give to each other by the execution
of this Agreement a full, complete and general release with respect to any and all
property I,of any kind or nature, real, personal or mixed, which the other now owns or
may hereafter acquire, except and only except all right and agreements and obligations
of whatsoever nature arising or which may arise under this Agreement or for the
breach of any provision thereof. It is further agreed that this Agreement shall be and
constitute a full and final resolution of any and all claims which each of the parties
may have against the other for equitable division of property, alimony, counsel fees
and expenses, alimony pendente lite or any other claims pursuant to the Pennsylvania
Divorce Code or the divorce laws of any other jurisdiction.
SECTION FOURTEEN
ADVISE OF COUNSEL
The provisions of this Agreement and their legal effect have been fully explained
to Leanne M. Via by Gary L. Martin, Esquire, attorney for Leanne M. Via. Supreme
A. Shabazz agrees that he has voluntarily chosen not to be represented by legal
counsel in this matter and hereby waives all claims and defenses that he was not
adequately represented by legal counsel in this matter. The parties hereto accept that
this Agreement is, in the circumstances, fair and equitable and that it is being entered
into freely and voluntarily and that execution of this Agreement is not the result of
any duress or undue influence and that it is not the result of any collusion or improper
or illegal!, agreement or agreements. The parties further acknowledge that they have
each made to the other a full accounting of their respective assets, estate, liabilities,
and sources of income and that they waive any specific enumeration thereof for the
purpose of this Agreement. Each party agrees that he and she shall not at any future
time raise a defense or otherwise the lack of such disclosure in any legal proceeding
involving] this Agreement, with the exception of disclosure that may have been
fraudulently withheld.
Page 7 of 11
SECTION FIFTEEN
EXECUTION OF SUBSEQUENT DOCUMENTS
The parties will execute and deliver any other instruments or documents that
may be necessary or convenient to carry into effect the provisions of this agreement.
SECTION SIXTEEN
WRITTEN MODIFICATIONS
No Modification or waiver of any of the terms hereof shall be valid unless in
writing and signed by both parties and no waiver of any breach hereof or default
hereunder shall be deemed a waiver of any subsequent default of the same or similar
nature.
SECTION SEVENTEEN
MUTUAL COOPERATION
Each party shall, at any time and from time to time hereafter, take any and all
steps and execute, acknowledge and deliver to the other party any and all further
instrum;nts and/or documents that the other party may reasonably require for the
purpose lof giving full force and effect to the provisions of this Agreement.
SECTION EIGHTEEN
APPLICABLE LAW
This Agreement shall be construed in accordance with the laws of the
Commonwealth of Pennsylvania which are in effect as of the date of execution of this
Agreement.
SECTION NINETEEN
BINDING AGREEMENT
This Agreement shall be binding and shall inure to the benefits of the parties
hereto and their respective heirs, executors, administrators, successors and assigns.
SECTION TWENTY
INTEGRATION
This agreement constitutes the entire understanding of the parties and
supersedes any and all prior agreements and negotiations between them. There are
no representations or warranties other than those expressly set forth herein.
Page 8 of 11
SECTION TWENTY-ONE
NO WAIVER OF DEFAULT
This Agreement shall remain in full force and effect unless and until terminated
under and pursuant to the terms of this Agreement. The failure of either party to
insist upon strict performance of any of the provisions of this Agreement shall in no
way affect the right of such party hereafter to enforce the same, nor shall the waiver
of any default or breach of any provisions hereof be construed as a waiver of any
subsequent default or breach of the same or similar nature, nor shall it be construed
as a waiver of strict performance of any other obligations herein.
SECTION TWENTY-TWO
SEVERABILITY
If, any term, condition, clause or provisions of this Agreement shall be
determined or declared to be void or invalid in law or otherwise, then only that term,
condition, clause or provision shall be stricken from this Agreement and in all other
respects this Agreement shall be valid and continue in full force, effect and operation.
Likewis , the failure of any party to meet her or his obligation under any one or more
of the paragraphs herein, with the exception of the satisfaction of the conditions
precedent, shall in no way avoid or alter the remaining obligations of the parties.
SECTION TWENTY-THREE
BREACH
If either party breaches any provisions of this Agreement, the other party shall
have the right, at his or her election, to sue for damages for such breach or seek such
other remedies or relief as may be available to him or her, and the party breaching this
contract; shall be responsible for payment of reasonable legal fees and costs incurred
by the o?her in enforcing their rights under this agreement.
SECTION TWENTY-FOUR
HEADINGS NOT PART OF AGREEMENT
Ao: y heading preceding the text of the several paragraphs and subparagraphs
hereof are inserted solely for convenience of reference and shall not constitute a part
of this Agreement nor shall they affect its meaning, construction or effect.
SECTION TWENTY-FIVE
TAX DEDUCTIONS AND CREDITS
Leanne M. Via shall claim the child as a dependent on all state and federal tax
returns.', Leanne M. Via shall also claim all costs of child care as a credit on state and
Page 9 of II
federal tax returns. Supreme A. Shabazz hereby releases and relinquishes all right to
take any or all of such deductions and credits on tax returns.
THIS AGREEMENT SHALL BE BINDING ON THE RESPECTIVE HEIRS,
EXECUTORS, ADMINISTRATORS, AND ASSIGNS OF THE PARTIES.
IN WITNESS WHEREOF, WE HAVE HEREUNTO SIGNED OUR NAMES,
THE DAY AND YEAR PROVIDED ABOVE, INTENDING TO BE LEGALLY BOUND
HEREBY.
WITNESS:
j
4"" -f//, - 64?'
BY: Leann &M. Via
BY: ,
Supreme A. Shaba
COMMONWEALTH OF PENNSYLVANIA
SS.
COUNTY OF D('tL4).. I")
On they ` day of A,( 119 before me, a
Notary Public, personally appeared Leanne M. Via known to me to be the person
whose name is subscribed to the within document, and acknowledged that she executed
the foregoing for the purposes therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and Notarial Seal.
WAN A VELEZ
Notary Public, tate of New or
No. 01 E5035081
Qualified in Kings County
Commission Expires Oct. 24, 1998
NOTARY PUBLIC
NOTARIAL SEAL
LEAH R. MARTIN, Notary Public
City of Harrisburg, Dauphin County
My Commission Expires M- rch B, 2000
Page 10 of 11
STATE OF b+o %.>J o v-?-
SS.
COUNTY OF c ;
On the day of -yu o e , 19 before me, a
Notary Public, personally appeared Supreme A. Shabazz, f/k/a Lee M. Settle, a/k/a
Larry A. Johnson known to me to be the person whose name is subscribed to the
within document, and acknowledged that he executed the foregoing for the purposes
therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and Notarial Seal.
WA DA VELEZ
Notary -c .State of New York
Q. 0 VF5035021
Qualified i Kings County
Commission `-*rires Oct. 24, I?Ss
NOTARY PUBLIK:_
Page 11 of 11
SP 4-198 (11-99)
PENNSYLVANIA STATE POLICE
CENTRAL REPOSITORY
1800 ELMERTON AVENUE
HARRISBURG, PA 17110
717-783-3762
DATE: Monday, August 27, 2012
PROTHONOTARY RE: SID:
CUMBERLAND CO COURTHOUSE NAME: VIA TARIQUE C
1 COURT HOUSE SQUARE SOC:
CARLISLE, PA 17013 COURT DOCKET #: 12-5223-CV
the fingerprint cards of the above named individua~ivhaw
In accordance with the Name Change Act of 1998
,
has applied for a name change, has been searched in the files of the Pennsylvania State Police, Criminal Ree~i~anc~a '-t
Identification Division Central Repository, and: ~~ ~ r~~1 ~''
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( X) This person is not subject to 18 PA C.S. Chapter 91, and the fingerprints have been destroyed.
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OThis person is subject to 18 PA C.S. Chapter 91, and the name change has been noted on the person sip,. ~„ ~ ~ ~°"~"a
criminal history record information. ~~ W ~~
IN ACCORDANCE WITH THE 1~M&J
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CHANGE ACT, THE COURT SHALL NOTIFY THE PENNSYLVANIA STATE POLICE WHEN A 1QAME~ ~
CHANGE FOR A PERSON CONVICTED OF A FELONY HAS BEEN 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-
f'urnished information against a name index and fingerprints contained in the files 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 contact us at the above address or
telephone number.
Sincerely,
Director, Criminal Records
and Identification Division