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HomeMy WebLinkAbout12-6189,_ t IN THE COURT OF COMMON PLEASE OF CUMBERLAND COUNTY, PENNSYLVANIA nv RE: Sarah Ca~nero . NAME CHANGE OF File No. / ~` ~ -~- - SUkVIVING SPQUSE t ' n --,t r_ -rr -~ ~ ~ o~ ~~ TO ~ ~~~ s ~~ ~~g (PLEASE PRINT OR TYPE) x. c~ . Notice is hereby. given that the above named Petitioner, `~ ~' ,,~. Saa~ah Caner residing at, 31 Q5 Chestnut Strut PA 171)11 Camp Hill , , being a Surviving spouse as of September ~ 6 2012 hereby intends to resume and hereafter use the previous name of Saul Switzer and gives this written notice avowing his /her .intention pursuant to the provisions of 54 Pa.C.S. § 7(}4.1. A Certified copy of the CertiftCate of Dneth for the decedent is attached. Date: lb~~~/~- Si ' of Petitic~~er ~~ Signature of nmg resumed COMM+©NWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND On the o~ day of ~ l.~, before me, the Prothonotary or the notary public, pcally appeared above affiant known to me to be the perscm whose name is subscribed to the within document end acknowledged that he /she ex~uted the forgoing. for the purpose therein contained. In Witness Whereof, I have hereunto set my hand and ofFical seal. ;. ;.~ ~ _ ~ ~+- ts~~. (Nrertoz Thl~ mat na-tst be aaeo~pxaed'bry as a +a~te of destth 1~ur the dexxden ) ~$k~3•'~5 1~0 ~~?y ~~ ...5 Vn5 -.. _ ~ 1 ~ - ~ Lt)CAL F~~1~7RAR'S CERT1~fCATIQN CAF DEATH WARNHVG: 1t is illegal to duplicaite #~ts capy by photostat or photograph. Fee for this certificate, $6.00 This is to certify that the information here given is correctly copied from an original Certificate ~fDcath duly filed with me-as Loyal Registrar. The original certificate will' be 'forwarded to the State Vital Records Office for permanent filing. ', P 188005Q4 ~; ' Certification Number _ -- ~ _ _- Local Registrar _ _ __. .. _ _ - . Date_Is~ued. 7ype/Prlnt M ~ OOhMNONWEALTN OF.PENNtYLVANIA • DpARTMENT OP NEAITN ~ VITAL R6COR05 i C'_`tF~HlM~tR AC l1~ATf.~ ~~ Keare . tMR.. !ac nM t i 7f~2 9~tINS-b•r 6. 2012 V aa! ~, ry ti i ~, Q 3.~ ~. tcaYntvl M ClS1IntlVi asav (stlre t tplnlbar - t. • A-t No./ t.. a ToVrnahlp (w}YSa, dae~deM Iwad In tWP- . / 4 daesM~M'IiwMl whMn e/nile d dtY .. o. .! nelM b' lf6HIMT/w! .Q Yet iJ111la1eMln Q CIMMc~O ~ [~ IetYw FMntad ~ tJMnown Si. s R w S- IWIItN Flrat Laet) a . IP b 106. et acrd u . ~~ ..... y~~ ....... !M . ~.y ~-t~ '~~ _.. ~ue1tMMWW Mra~• ••t~•~~ ine/Pb~:•• ••'•y ~iuiVllfr•Pe ~~ttY• ••W 13ia1~OinersMOrn~~ O[M! aol o! of D}ath. Fiatriaqu R 17t 1 [~ n k n [7 Ra.+,.a..wa«.s.... 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