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HomeMy WebLinkAbout13-4473 r1 uut bepaathd IN THE COURT OF COMMON PLEAS OF COUNTY, PENNSYLVANIA CIVIL DIVISION THE COMMONWEALTH OF PENNSYLVANIA COUNTY OF (-) ce"= t�F; Plaintiff r'�` ` t3 � yL/`7.3 vs. No. - Defendant PETITION FOR LEAVE TO PROCEED IN FORMA PAUPERISE AND NOW, comes the (plaintiff/defendant) //ALE c%it and respectfully requests this Honorable Ccurt for leave to proceed in Forma Pauperis in the above captioned case. In support of this Pe'ition, (plaintiff/defendant)avers as follows: 1. (Plaintiff/defendant) desires to commence a (Civil Action/Appeal)to the Court of Common Pleas but is without the funds to pay the filing fee. 2. (Plaintiff's/defendant's)financial affairs are set forth in a Verified Statement, a copy of which is attact4ed to this petition as Exhibit A. 3. If( ;iintiff/defendant) is not permitted to commence a (Civil Action/Appeal) in Forma Pauperis, he/she will be denied due process of law and/or his/her rights under the Constitution of the United States and the Constitution of the Commonwealth of Pennsylvania. 4. (Plaintiff/defendant) has never been denied leave to proceed in Forma Pauperis in any case. Wherefore, (plaintiff/defendant) prays this Honorable Court to grant this Petition and to allow him/her to proceed without payment of the required fees. RESPECTFULLY SUBMITTED Plaintiff/Defendant era/ IN THE COURT OF COMMON PLEAS OFAIMILmeleriNY COUNTY, PENNSYLVANIA CIVIL DIVISION THE COMMONWEALTH OF PENNSYLVANIA COUNTY OF c_ur-,r/�-en I ,✓ Plaintiff vs. No. f,3 - 73 Defendant IN FORMA PAUPERIS VERIFIED STATEMENT 1. I am the (plaintiff/defendant) in the above matter and because of my financial condition am unable to pay the fees and costs of prosecuting or defending this action or proceeding. 2. 1 am unable to obtain funds from anyone, including my family and associates, to pay the costs of litigation. 3. I represent that the information below relating to my ability to pay the fees and costs is true and correct: (a) Name: Ai.-eehL; C o LLZi✓s Address: ,Pc . 13c ,,2©c Phone: /.1/, /9 City: C e2/4,71—/-y State: P/9. Zip Code: /7 /—"z , (b) EMPLOYMENT If you are presently employed complete the following: Employer: ,V//5 Phone: ,r/z//.9 Address: — Arl9 Employee ID: 4/7,9 City: /1/4 State: A/7/57 Zip Code: .x/09 Monthly salary or wages: $ A/4 Type of Work: 4/-4e'9 If you are presently unemployed, please complete the following: Date last worked: o'v /4. ,e .. Monthly salary or wages: $ cc.) A p-rori Type of work: Q� Tin � a/c � q-7" (c) OTHER INCOME WITHIN THE PAST TWELVE (12) MONTHS (list amounts and explain) Business or profession: $ /1// ` Other self-employment: $ Interest earned: $ /7/9 Dividends: $ .14. Pension and annuities: $ /1 � ._... SociaLSe<.u�at .hentefi � Support payments: $ /1 .4 Disability payments: $ �� Unemployment compensation and supplemental benefits: Workmen's compensation: $ /Zi; Public Assistance: $ .14 Other(explain): $ ///f1`" (d) OTHER CONTRIBUTIONS TO HOUSEHOLD SUPPORT (Wife's/Husband's) Name: f�r�i �e�LP_ 6�°'/� c L w Employer: dx./7"" /i%/c4 Phone: Address: ���./��/ir/r,- Employee ID: /�-r.erzi City: C'o 7 /'AZ ,v' State: 04/7-.C''eivZip Code: (74/7"/>✓rvh� Monthly salary or wages: $ e,‘,C- rz Type of Work: /4 z Contributions from children: $ 414 Contributions from parents: $ A/evv,G Other contributions (explain): $ 44'4 (e) PROPERTY OWNED Cash: $ A/Gq/'e. Checking Account: $ ,t'b,t4. Savings Account: $ ir/o,t/e Certificates of Deposit (CD's): $ 44/3,442_ Stock/Bonds: $ //© Real Estate (including house):$ ,i/o'/t/e_ Motor vehicle(s): Make: /Vole_ Model: 444/6_ Year: A/a4- Purchase price: $ ,t/)n/e- Amount owed: $ Make: /)//,4/e Model: 444/e Year: 4/�?e. Purchase price: $ .t/o,1/, Amount owed: $ 't64/ Other (explain): $ (f) DEBTS AND OBLIGATIONS Mortgage: $ 4/g,w. Rent: $ A/a Loans: $ ,✓o-Ve_ Other(explain): $ -vb44 ' (g) PERSONS DEPENDENT UPON YOU FOR SUPPORT (Wife's/Husband's) Name: _ A/ei A/E. _ Children, if any: Name: Age: /o Name: z/7- Age: $ Name: )9,,.�/.2 .S e2f�coA/ /1�.�6 `'�l>-4✓s Age: /3 Other persons: Name: A��/0,,l Relationship: it/a47e_ Name: /i7 .4/e Relationship: .,/0ye- 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. 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., paragraph 4904, relating to unsworn falsification to authorities. DATE: PETITIONER: Aec,7884.--Tc% Integrated Offender Case Management System 7/1/2013 9:25:04 AM Monthly Account Statement From Date: 6/1/2013 To Date: 6/30/2013 Institution: CAM -Camp Hill 12:00:00 AM 12:00:00 AM ocation Case 113 Offender Name Current Balance Escrow Balanc= AM-E-C-1010-01 GZ8313 COLLINS,FREDERICK 413.43 0.0' Batch# Txn Date Txn Description Txn Amount($) Balance After Transaction($) CAM-018080 06/28/2013 36-Copies 0.10 -413.43 Right To Know Available Balance 413.43 r. Page 695 of 3406 C I 16 ILE��OURT OF COMMON PLEAS COUNTY, PENNSYLVANIA In Re the Petition of: frte,41. / .90tei/ c 442-4,,s (PRINT YOUR NAME) 13a 1LI 73 For a Name Change to: Docket No. 4 ,4, (^)/1/ 1111111111M, ,�Ar, e✓ (PRINT NEW NAME) VERIFIED PETITION FOR A NAME CHANGE And now comes Petitioner(s) / t --, ��05 k45 Lee- C.oL.L4/S By this petition and upon being duly sworn, respectfully represents and shows. unto the Court: 1. That the Petitioer(s) is of full legal age and is a bonafide resident of the County of Commonwealth of Pennsylvania, whose resides at : o, &oX -,oC) C■C(- M L4, P y9. /700/- o,2 act Guxt Qtti_Q,r5' Petitioner(s) has been a bona fide resident ofiy County, State of Pennsylvania for pm-(s) immedi tely prior to filing this Petition. Petitioner(s) was born on the 5,-c day of,✓ovea.c(J Q/4„ (month), /79 (year), in the County of 61/,.,L 2y'/_e./y State of ye✓,✓s/L,i ?-c Country of r',,,; e/ s 7 oA' f9oi c 4_ • 2. Petitioner's present name is ,tiq. U, o .54as Lee_ c_a/..,4rN3 3. Petitioner(s) is not married /,e.s .r is married to: C7tirf Te- 4. That the Petitioner(s) is the Father Mother of the following minor children. None: Name Birthdate Age /97 ..o /h-O,✓/7 re. Gold.✓s 7--Z� c c'c) /3 /0 5. Petitioner(s)has resided at the following address(es) over the last five(5)years: Odd ,e0 rCS PLZ OaLte ,O# /86i/� Z /gyp LL/ /d. rrDr�l.7 �/ /1',Q./78'6/ a, �S/ .Zct� c pl�r/G /loo/-ode.co 6. That the Petitioner(s)pray's for the change of name for the following reasons: Describe in detail: i ii d Z4/ tik_L/1:?: p_ / c�� 9f��s M- �.�� n°1�<. r.r e. d�sirt ZcT/9/'�D i/E'1�,4 n ' ,o7 4 2 7" 4/0re /As ta47" oi✓ et nA,Z �✓< /7/z-nee�ev"' 3°�cr 2-� ec l� f f �� � 7' rs/G ::n, '/ -� fij4o' 4i✓ 4�i,�/rT Ci✓��Qrk � ,° Be n..// Lr4r.1� 6e- A_ewi?Q se/ ri/Or.. 9r^iso i/ Mohr ' cege..5- ,9o2it o f�l �e eu../l� ,A.ci�,' tea/L or ec� L4! .aca7� i j S - ''/It That the proposed change in the Petitioner(s) name, if granted, will not be detrimental to • the interests of any other person and is not against the public interest. This petition is not filed to defraud creditors. Wherefore, the Petitioner(s) pray(s) that by an Order of this Court, made and entered herein, the Petitioner(s)name be changed to and decreed to be: Respectfully Submitted, Signature Address: f. 0. 60 P./9- /70o/—C7aZ 7C Phone: AZ,ff IN THE COURT OF COMMON PLEAS ALLEGHENY COUNTY, PENNSYLVANIA VERIFICATION I, k ,41- il/ te�Z4s Z:e.e_ , verify that The statements made in the foregoing Petition are true and correct to the best of my knowledge or information and belief. I understand that this verification'is made subject to the penalties of 18 Pa. C.S.A. Sec. 4904 relating to unworn provides that if I knowingly make false averments, I may be subject to criminal penalties. Date Signature ...-. ---- ' - H....AV.: :... ■ '.. 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I , - M/ ; 1., M, -711 Z. / c.otco.er,Lez 4/o/ cwa. mco C-- c= • XC,49 r-- c.4 as e /Vez_a<c. '77 e.- 7ey e. -2":" /p9/ If> /tz /2.Z271, ‘;`47-f2t-Cr; fL e, i)70 ;2:, ele, tic,/ pa— 0A/ ie oA. h4 /„L e.;it 4z 4- "%a..1214•Ce.- 717/0 k7e.ve"- /51/ ete—t /mi./ 4 „pet-4-L/ / /.??,1 e-€14,- c/i7:2—c: cv7 ' 11/c/ ,944c4=V pkczy. -4 re/1.-...14 e 13c 2---;k5" ()Le "rtie- /-'""e" 6e2%., j_2",z*, Q -:277V 4/7.."1" e L 6 e (1_8. ctfa."14 e -7 2/t 41,4 c4 /if/ d— ' /144. 7.4 e C. 4,-(4/7ji / L-1 ,"/ effx._ e_ e- e _pi-e /je ir77 .74 e(k. 4 /- OE- /V1i4 ftC/eilt-' e e_ .07/ 7 Xe Z79- zzc 02 cye, c2.41"/ "., c ria-lcze e e44,1 1,`..27-74 -49- -P-1-4. 37/ 5Q 4.-a4s-,,c,/ crux ) eh_ 4.47,4(e Pezzi erh-r_s eL4/0/ c . ci,e; ot/Id. ,v• T p�- .✓(re �z _ C_ . =/l�i�//'� /c(.i, r2421.11.- yGLi,{� /mot /*t4.rrelt, /c1(/h. C 'r"-'1-c:e. kez aewn/ ve v/ }� `��f cA,t,e7 X e1� , . / 4r C&zb?2/3 F",1/4_e /e GZ e_3_63 e. ps9, /7007-Q9_00 o9_c (7.1 N - A ? 1‘k \. c .1"t3 "t;-\1/4 s;. cl\ .k\s co 9Z inr SZ£11:3£1.00 OV V ULM LOOLL Atamossualmar.diumantr."4""a" *,40 ammismomorimjzz,tri .„ k.N S3M08 A3NlIci<<3evisOci St 0 rr1:21 rn n > 0,41 . t iN THE COURT OF COMMON PLEAS OF 0 COUNTY, PENNSYLVANIA CIVIL DIVISION THE COMMONWEALTH OF PENNSYLVANIA COUNTY OF Plaintiff No. 13 qqr7 3 ZC Defendant cu> s .. ri ORDER OF COURT AND NOW, to-wit, this Jr eA, day of 201 , upon consideration of the foregoing Petition, it is hereby ORDERED, ADJUDGED and DECREED that the petitioner be and hereby is permitted to file and pursue his/her appeal/action in the above-captioned case without payment of costs or fees. BY THE COURT Ceir mz.�� � Jr tec-L J. (2a Lu, SP 4-198 (11-99) PENNSYLVANIA STATE POLICE CENTRAL REPOSITORY 1800 ELMERTON AVENUE HARRISBURG, PA 17110 717-783-3762 DATE: Thursday, August 08, 2013 PROTHONOTARY RE: SID: 23-531-63-1 CUMBERLAND CO COURTHOUSE NAME: COLLINS FREDERI DOUG 1 COURT HOUSE SQUARE SOC: 205-60-2631 CARLISLE, PA 17013 COURT DOCKET #: 13-4473 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: 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 BEEN ORDERED. The Pennsylvania State Police, upon receipt of this notice, shall include the change of name information in the Central Repository as gprovided fo in 1 PA C.S.,C 91 relati o crimin 1. i o ti n an e is rantel, please no ' our owi ce us�i�11 Ytx�d`�4��a'��1�'�� `�'u gr �0��. 9 ( )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 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, ' r Director,Criminal Records and Identification Division t' C— C- CD , 7 I YY � J� SP4-137B COMPILED: 2013/08/08 PAGE: 1 of 4 PENNSYLVANIA STATE POLICE CENTRAL REPOSITORY 1800 ET RTON AVENUE HARRISBURG, PENNSYLVANIA 17110 (717) 787-9092 -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- USE OF THE FOLLOWING CRIMINAL HISTORY RECORD *** SID 235-31-63-1 *** REGULATED BY ACT 47, AS AMENDED. -----------------=-------------------------------------------------------------- -------------------------------------------------------------------------------- IDENTIFICATION NAME: COLLINS,FREDERICK DOUGLAS SID: 235-31-63-1 DOB: 1980/11/03 SOC: XXX-XX-2631 SEX: MALE RAC: BLACK HAI: BLACK EYE: BROWN HGT: 5105" WGT: 140 POB: US CITIZEN: YES COUNTRY OF CITIZENSHIP: -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- CRIMINAL HISTORY NAME: COLLINS,FREDERICK DOUGLASLEE OTN: G070837-4 ARRESTED: 1999/09/18 PAPPD0000 PITTSBURGH PD OCA: 297289 DISPO DATE: 2001/11/19 COMMON PLEAS DOCKET: CP-02-CR-0014932-1999 OFFENSE DISP DATE CHARGE COUNT GRADE CHG DISPOSITION ------- ------ ----- ----- ------ ------------ 1999/09/18 CC2702A AGGRAVATED 1 F1 PLEAD GUILTY/ ASSAULT COUNTY PROBATION 1999/09/18 CC3702A ROBBERY OF 1 F1 PLEAD GUILTY/ MOTOR VEHICLE COSTS/ COUNTY PROBATION/ 005 YRS 1999/09/18 CC2705 RECKLESSLY 3 M2 PLEAD GUILTY/ ENDANGERING COUNTY PROBATION ANOTHER PERSON 1999/09/18 CC4304A ENDANGERING 2 M1 PLEAD GUILTY/ WELFARE OF CHILD COUNTY PROBATION -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- NAME: COLLINS,FREDRICK OTN: G093357-5 ARRESTED: 2001/02/15 PAPPD0000 PITTSBURGH PD OCA: 297289 DISPO DATE: 2001/11/19 COMMON PLEAS DOCKET: CP-02-CR-0001967-2001 OFFENSE DISP DATE CHARGE COUNT GRADE CHG DISPOSITION ------- -----= ----- ----- ------ ------------ 2000/11/05 CC3701AI ROBBERY 1 F2 COSTS/ PLEAD GUILTY/ COUNTY PROBATION/ 005 YRS ---------------------------------------------------=---------------------------- -------------------------------------------------------------------------------- NAME: COLLINS,FREDERICK DOUGLASSLE OTN: H652881-5 ARRESTED: 2002/03/07 PA0027900 MOUNT OLIVER OCA: 297289 DISPO DATE: 2002/07/18 DISTRICT JUSTICE: '05315 SP4-137B CRIMINAL HISTORY RECORD - CONTINUATION FOR *** 235-31-63-1 *** COMPILED: 2013/08/08 PAGE: 2 of 4 OFFENSE DISP DATE CHARGE COUNT GRADE CHG DISPOSITION ------- ------- ----- ----- ------ ------------ 2002/03/07 CS13A16 POSSESSION OF 1 PLEAD GUILTY A CONTROLLED SUBSTANCE BY AN UNREGISTERED PERSON EXCEPT BY PRESCRIPTION IS UNLAWFUL 2002/03/07 CS13A30 MANUFACTURE 1 PLEAD GUILTY/ ETC. OF COUNTY PRISON/ CONTROLLED 09 MOS - 001 YRS SUBSTANCE BY 11 MOS PERSON NOT REGISTERED, OR A PRACTITIONER NOT REGISTERED CREATING, ETC. A COUNTERFEIT CONTROLLED SUBSTANCE ------------ NAME: COLLINS,FREDERICK DOUGLASSLEE OTN: H708577-2 ARRESTED: 2002/06/15 PA0021300 MCKEESPORT PD OCA: UNKNOWN DISPO DATE: 2002/10/18 DISTRICT JUSTICE: 05213 OFFENSE DISP DATE CHARGE COUNT GRADE CHG DISPOSITION ------- ------ ----- ----- ------ ------------ 2002/06/15 CC5121 ESCAPE 1 PLEAD GUILTY/ COUNTY PRISON/ 09 MOS - 001 YRS 06 MOS/ FINES AND COSTS 2002/06/15 CC5503 DISORDERLY 1 M3 PLEAD GUILTY CONDUCT NAME: COLLINS,FREDERICK OTN: H791105-0 ARRESTED: 2002/10/30 PA0022800 ALLEGHENY COUNTY OCA: 297289 DISPO DATE: 2003/06/17 COMMON PLEAS DOCKET: CP-02-CR-0002256-2003 OFFENSE DISP DATE CHARGE COUNT GRADE CHG DISPOSITION ------- ------ ----- ----- ------ ------------ 2002/10/23 CC3307 INSTITUTIONAL 1 M2 PLEAD GUILTY/ VANDALISM COSTS/ COUNTY PRISON/ 06 MOS - 12 MOS 2002/10/23 CC3305 INJURING OR 1 M3 PLEAD GUILTY TAMPERING WITH FIRE APPARATUS, HYDRANTS, ETC. NAME: COLLINS,FREDERICK DOUGLASSLE OTN: K030682-1 ARRESTED: 2004/01/22 PA0022800 ALLEGHENY COUNTY OCA: 297289 DISPO DATE: 2007/03/15 S114-137B CRIMINAL HISTORY RECORD - CONTINUATION FOR *** 235-31-63-1 *** COMPILED: 2013/08/08 PAGE: 3 of 4 DISTRICT JUSTICE: 05 OFFENSE DISP DATE CHARGE COUNT GRADE CHG DISPOSITION ------- ------ ----- ----- ------ ------------ 2004/01/22 CS13A30 MANUFACTURE 1 F PLEAD GUILTY ETC. OF CONTROLLED SUBSTANCE BY PERSON NOT REGISTERED, OR A PRACTITIONER NOT REGISTERED CREATING, ETC. A COUNTERFEIT CONTROLLED SUBSTANCE 2004/01/22 CS13A16 POSSESSION OF 1 M PLEAD GUILTY A CONTROLLED SUBSTANCE BY AN UNREGISTERED PERSON EXCEPT BY PRESCRIPTION IS UNLAWFUL 2004/01/22 CS13A31 PROHIBITS 1 M PLEAD GUILTY POSSESSION AND/OR DISTRIBUTION OF SMALL AMOUNTS OF MARIHUANA AND DEFINES SMALL AMOUNT 2004/01/22 CS13A32 USE OF DRUG 1 M PLEAD GUILTY PARAPHERNALIA FOR PURPOSES IN VIOLATION OF THIS ACT PROBATION/PAROLE INFORMATION START END LIFE AGENCY OCA DATE DATE PAR/PRO CODE ------ --- ----- ----- ------- ---- PA002013G ALLEGHENY 2003/03/03 2008/03/03 PROBATION CO ADULT PROBATION APPLIES TO OTN: G070837-4 PA002013G ALLEGHENY 2003/03/03 2008/03/03 PROBATION CO ADULT PROBATION APPLIES TO OTN: G093357-5 PA002013G ALLEGHENY 2003/07/23 2004/05/18 PAROLE CO ADULT PROBATION APPLIES TO OTN: H652881-5 ADDITIONAL IDENTIFIERS AKAs: COLLINS,FRED / COLLINS,FREDERICK DOUGLAS / COLLINS,FREDERICK LEE DOBs: 1980/11/30 sOCs: SR4-137B CRIMINAL HISTORY RECORD - CONTINUATION FOR *** 235-31-63-1 *** COMPILED: 2013/08/08 PAGE: 4 of 4 MNUS. -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- F=FELONY, M=MISDEMEANOR, S=SUMMARY AND THE NUMERIC=DEGREE ARREST(S) SUPPORTED BY FINGERPRINT CARD(S) ON FILE RESPONSE BASED ON COMPARISON OF REQUESTER FURNISHED INFORMATION AND/OR FINGERPRINTS AGAINST A NAME INDEX AND/OR 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 CONTAINED IN THE REPOSITORIES OF OTHER LOCAL, STATE, OR FEDERAL CRIMINAL JUSTICE AGENCIES. ****************************** END OF RAP SHEET ***************************** IN THE COURT OF COMMON PLEAS COUNTY, PENNSYLVANIA In Re the Petition of: �iLe f /�/ A-.s Lee- (PRINT YOUR NAME) t m=rn rn rTi f-y For a Name Change to: Docket No. ,20/3 z7 ' a - D c� 4._621J'cm✓ ivQ A (PRINT NEW NAME) - VERIFIED PETITION FOR A NAME CHANGE And now comes Petitioner(s) ��P�,%Gj � ,e By this petition and upon being duly sworn, respectfully represents and shows. unto the Court: 1. That the Petitioner((ss) of full legal age and is a bonafide resident of the County of Commonwealth of Pennsylvania, whose resides at : X e, 0?0,Y 2ec➢ 7M -7.-G}, . /76,0/- Petitioner(s) has been a bona fide resident of ige,�„la.�✓�✓ ( ) County, State of Pennsylvania for /a ,,,o , , 1r(s) immeditely prior to filing this Petition. Petitioner(s) was born on the 3'z day of/17,01&,,-I6 (month), j/mod (year), in the County ofy State of ,Pe,✓,,,%/L'2 / -cL Country of 6//,,S. .,-7 s�= 2. Petitioner's present name is %La.0 3. Petitioner(s) is not married Er-II-married EfiL 4. That the Petitioner(s) is the )( Father Mother of the following minor children. None: Name Birthdate Age ..5■62-PV,11/ irlevtz-e, zv 41P kvea gt4 .-"e, c_,01-1.," / c,c7 5. Petitioner(s)has resided at the following address(es) over the last five(5) years: lope. / '/J-'es /2,-0/: e- 44,5', I /9. /7.0"‘ (2, 13c)/r R. /9. ?ad/- 6. That the Petitioner(s) pray's for the change of name for the following reasons: Describe in detail: et-,z4/;77 Zr15 i/i "2:2 11-1 ,.‘,2•W 01"/'"Z- et,/ Siic_'77c-4 Z-z-ri--r- 2-;-7 t2/4_s a,t7 2f:5 "PeciVe iweAt. 5 51/6.C7; _6.1 'f3c /776 1).,62- P / eri..,777,/s ey,'■ 1,>-" • e ij /Iv ' V That the proposed change in the Petitioner(s) name, if granted, will not be detrimental to • the interests of any other person and is not against the public interest. This petition is not filed to defraud creditors. Wherefore, the Petitioner(s) pray(s) that by an Order of this Court, made and entered herein, the Petitioner(s) name be changed to and decreed to be: Respectfully Submitted, Signature Address: d. 2 r,,,Y -700/-Oaa cs Phone: .r//it IN THE COURT OF COMMON PLEAS COUNTY, PENNSYLVANIA c` 4., VERIFICATION I, -e ., A c� y<<rs •er= Co ZZ Y7i/S. , verify that The statements made in the foregoing Petition are true and correct to the best of my knowledge or information and belief. I understand that this verification is made subject to the penalties of 18 Pa. C.S.A. Sec. 4904 relating to unsworn provides that if I knowingly make false averments, I may be subject to criminal penalties. Date Signature • IN THE COURT OF COMMON PLEAS COUNTY, PENNSYLVANIA IN RE: PETITION OF GD: A-e 406 eic a.S Zee. ORDER SCHEDULING HEARING OF NAME CHANGE AND NOW, this day of 20 Upon hearing of the within motion of: Esquire/pro se, attorney for the Petitioner(s) above named, it is ORDERED AND DECREED that the within petition be heard on the day of 20 at before the Motions Judge. Petitioner(s) shall obtain a judgment search from all counties in which he/she has resided during the last five(5) years. IT IS FURTHER ORDERED that the Petitioner(s) shall obtain an affidavit of consent from the non-petitioning parent and/or serve a copy of this scheduling order by certified and regular mail forthwith. IT IS FURTHER ORDERED, that the Petitioner(s) shall advertise once in the cetv)-12 Legal Journal and once in a newspaper of general circulation in the county in which the Petitioner(s) resides. BY THE COURT, IN THE COURT OF COMMON PLEAS COUNTY, PENNSYLVANIA IN RE: PETITION OF GD: Petitioner(s) DECREE FOR CHANGE OF NAME AND NOW, this day of 20 Upon hearing the within Petition and upon motion of Esquire/Pro Se, attorney for Petitioner(s), with proof of publication and proof that there are no judgments or decrees of record or any other matter of like effect against Petitioner(s) and it appearing that there are no legal objections to the granting of the prayer of the Petition, it is ORDERED AND DECREED that the name(s) of the Petitioner(s) be and are, from and after this date changed to: BY THE COURT, IN THE COURT OF COMMON PLEAS COUNTY, PENNSYLVANIA ce-wee44+4111184,111,Zafr, IN RE: PETITION OF GD: _ ORDER SCHEDULING HEARING OF NAME CHANGE, AND NOW, this day of 20 Upon hearing of the within motion of: Esquire/pro se, attorney for the Petitioner(s) above named, it is ORDERED AND DECREED that the within petition be heard on the day of 20 at before the Motions Judge. Petitioner(s) shall obtain a judgment search from all counties in which he/she has resided during the last five (5) years. It is Ze- further ordered that the Petitioner(s) shall advertise once in the illagmik Legal Journal and once in a newspaper of general circulation in the county in which the Petitioner(s) resides. BY THE COURT: _ e II fde l--.b. c ,x eo - I�, 77"6:_ ACe,_ E v ti/ L' i o 1/ - - --_- iYCt,C_' 7t�-- �E' G2e ✓!L� �IS�eY �'.t�j,%�'CrG G'�= ,jC )1s'L0/1%7--1%- rL% '' r Gz .° C' -sec/, :z.Z w e_{,/ 7i-p� t. ,,,, Gzi g-'i'3 f _ _.-------- -__ II it IN RE: PETITION FOR IN THE COURT OF COMMON PLEAS OF CHANGE OF NAME OF CUMBERLAND COUNTY, PENNSYLVANIA FREDERICK DOUGLAS CIVIL ACTION - LAW LEE COLLINS NO. 13-4473 CIVIL TERM IN RE: PETITION FOR CHANGE OF NAME ORDER OF COURT AND NOW, this 10`h day of September, 2013, upon consideration of the attached Petition for Change of Name, a hearing is scheduled for Thursday, October 17 2013, at 2:30 p.m., in Courtroom No. 5, Cumberland County Courthouse, Carlisle, Pennsylvania. IT IS FURTHER ORDERED that notice of the filing of said Petition and the 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 prior to the hearing; in addition, Petitioners 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. §701 [Historical and Statutory Notes] [Main Volume]), and 54 Pa. C.S. §§701 et seq. Proof of these publications must be provided at the above-scheduled hearing. BY THE COURT, Christyke L. Peck, J. -,"✓�Frederick Douglas Lee Collins, GZ-8313 SCI-Camp Hill P.O. Box 200 c-1 C" Camp Hill, PA 17001-0200 MCC Petitioner, pro Se cn T) :rc -<ca >C-) is C5 ;z F. (2o >C: rs" —. _---, _.__.... ,:?;' ',,..,,,',",..- 4' .'• 4::','.I (0 CO M li wo Tr " co >- co 0 N III I ° ^ C/) L11 413- Go 0 ■ = ,,i't i5 ti \I 0 co N- c') 0_ ,.....1——(7, pd. .., .. 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'' 41) -, CC; 8 --‘71; a XI 0 C:S'.••/. • 0 C'n --''' A o a) •5 o o ,cr= ,• LI •If ,It 0 (-7 IN RE: PETITION FOR : IN THE COURT OF COMMON PLEAS OF CHANGE OFNAME OF : CUMBERLAND COUNTY, PENNSYLVANIA FREDERICK DOUGLAS : CIVIL ACTION—LAW LEE COLLINS : NO. 13-4473 CIVIL TERM IN RE: PETITION FOR CHANGE OF NAME ORDER OF COURT AND NOW, this 17th day of October, 2013, upon consideration of the Petition for Change of Name, and a hearing having been scheduled for Thursday, October 17, 2013, and the Defendant having stated to this Court through subsequent filings that he is currently incarcerated, and it appearing from public records that the Defendant is currently serving a sentence for a conviction of the Manufacture, Sale, Delivery or Possession with Intent To Deliver a Controlled Substance, an ungraded felony, and the Defendant having accordingly failed to meet the statutory requirements for a name change (see 54 Pa. C.S.A. §702(c), the petition for change of name is hereby denied and the hearing scheduled for October 17, 2013, is cancelled. BY THE COURT, fe( Christ ee L. Peck, J. Frederick Douglas Lee Collins, GZ-8313 SCI-Coal Township 1 Kelley Drive j f� Coal Township, PA 17866-1020 Oo� roe feel Petitioner, pro Se 10/11/1 :rc - "r�