HomeMy WebLinkAbout13-6738 ITT 25
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IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
In Re: Civil Action - Law w
Gabriel Joseph Rodgers Berkheimer NO. 13 — 6 Civil Term
born, 2/26/09
NAME CHANGE
PETITION FOR NAME CHANGE
AND NOW, comes Ashley M. Rodgers, Natural Mother of Gabriel Joseph
Rodgers Berkheimer, by and through her attorney, Jane Adams, Esquire and files her
petition to change her child's name, and support thereof avers as follows:
1. Petitioner, Ashley M. Rodgers, (hereinafter "Petitioner ") currently lives at 312
3` St., Summerdale, Pennsylvania, 17093.
2. Petitioner is the natural mother of Gabriel Joseph Rodgers Berkheimer, born
February 26, 2009.
3. Petitioner is seeking to change the name of Gabriel Joseph Rodgers
Berkheimer to Gabriel Joseph Rodgers.
4. The biological father of the child is Jason Levan Crawford. His rights were
terminated as part of an adoption.
5. Mother's former fianc6', Eric Michael Berkheimer adopted the child. The
child was given the last name of Berkheimer. After the adoption, Mother and her
fianc6' broke up.
6. Mother's former fianc6 then signed a custody stipulation that provided that
Mother would have legal custody and physical custody of the child.
7. Eric Michael Berkheimer has had no contact with the child since August
2012.
8. The child is under eighteen (18) years old and has no outstanding credit debt
that could be avoided through a name change.
9. The child has no outstanding federal or state tax debt that could be avoided
through a name change.
10. Petitioner is requesting that the child's name be changed to: Gabriel Joseph
Rodgers.
11. The child is scheduled to attend kindergarten in the fall of 2014.
12. Petitioner believes and avers that such name change would be in the best
interest of the child, as it would reduce confusion and conflict for the child when he
attends school.
WHEREFORE, Petitioner requests that this Honorable Court Order change the
child's name.
Respectfully submitted,
Date:
1 -1 f
e Adams, Esquire
No. 79465
W. Sout
517 h h St.
Carlisle, Pa. 17013
(717) 245 -8508
ATTORNEY FOR
PETITIONER
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OF PENNSYLVANIA - DEPARTMENT OF HEALT
v' VIIAL RFCORDS
of -,
DATE FILE
OF BIRTH February 26, 2009 NO 026774 -2009
COUNTY DATE
OF BIRTH DAUPHIN FILED March 19, 2009
DATE
ISSUED November 17, 2011
NAME SEX MALE
GABRIEL JOSEPH RODGERS BERKHEIMER
FATHER'S NAME
ERIC M BERKHEUV ER
MOTHER'S MAIDEN NAME
ASHLEY MICHELLE RODGERS
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_ This is to certify that this is a true copy of the record which Is on file In the Penns&anla Marina O'Reilly Matth w TM f NT 0 If ift'
Department of Health, in accordance with the Vital Statistics Law of 1953. as amended. State Registrar �i „�� �p!!f! _
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INS I ate. , ... .. _�
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H705.105AVV Rev. 8/11 THIS DOCUMENT IS PRINTED ON SECURITY WATERMARKED PAPER nr
_- WARNING: DO NOT ACCEPT WITHOUT VERIFYING THE PRESENCE OF THE WATERMARK. ' & It �' I h'
VERIFICATION
I verify that the statements made in this petition 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: 1(�l��l(3 Ashley M.: dgers, Pe tioner
s
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
In Re: Civil Action - Law
Gabriel Joseph Rodgers Berkheimer : NO. 13 — 6 `7 3 8 Civil Term
c.
born, 2126109
NAME CHANGE
rn
PRAECIPE TO PROCEED IN FORMA PAUPERIS < - -7.
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To the Prothonotary:
Kindly allow Petitioner, Ashley M. Rodgers, to proceed in forma pauperis
This case was referred by the Pro Bono Program of the Cumberland County Bar
Association. I, Jane Adams, attorney for the party proceeding in forma pauperis certify that
believe the party is unable to pay the costs and that I am providing free legal services to the
party. The party's affidavit showing inability to pay the costs of litigation is attached hereto.
Respectfully submitted,
Date: / / Q / /�
(1 1 t ( a Adams, Es q uire
I. No. 79465
7 W. South St.
Carlisle, Pa. 17013
(717) 245 -8508
ATTORNEY FOR PETITIONER
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
In Re: Civil Action - Law
Gabriel Joseph Rodgers Berkheimer NO. Civil Term
born, 2/26/09
NAME CHANGE
AFFIDAVIT IN SUPPORT OF PETITION
FOR EE A',/E TO PROCEED I "m FORMA PAUPERIS
1. 1 am the Petitioner in the above matter and because of my financial condition I am
unable to pay the fees and costs of prosecuting, defending, or appealing the action or
proceeding.
2. 1 am unable to obtain funds from anyone, including my family and associates, to pay
the costs of litigation.
3. 1 represent that the information below relating to my ability to pay the fees and costs
is true and correct.
(a) Name: Ashley M. Rodgers
Address: 312 3r St. Summerdale, Pennsylvania, 17093.
(b) Social Security Number: not provided in this document due to privacy concerns.
4. 1 am presently unemployed/ mploye (circle one)
If employed, list employer: 1
Hourly rate: 1CoC)0'_G � Id x�� c -
Hours per week worked:
I am am not on public assistance. (Circle one.)
I receive per month. \ r ` s1c x .��
6. 1 have no other source of income.
7. 1 do/ not ceive child support from the legal Father of the subject child of this
action. o
If yes, amount received per month:
8. My monthly rent expenses are per month.
9. 1 have no other property or resources from which I could withdraw funds to pay for
the filing and legal fees of this matter.
10. The persons who are dependent on me for support are:
Gabriel Joseph Rodgers Berkheimer, born February 26, 2009.
11. 1 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.
Signed,
- Ashley M. o gers, Petitioner
Date:
IN RE: GABRIEL JOSEPH RODGERS , i of On
BERKHEIMER, born 2/26/09 �� to
IN THE COURT OF COMMON PLEAS
OF THE NINTH JUDICIAL DISTRICT
2013-06738 CIVIL TERM
IN RE: PETITION FOR CHANGE OF NAME
ORDER OF COURT
AND NOW, this 21St day of November 2013, upon consideration of the Petition
for Change of Name, a HEARING shall be held on 8 January 2014 at 2:30 p.m. in
Courtroom Number Six of the Cumberland County Courthouse, One Courthouse
Square, Carlisle, Pennsylvania.
At least TEN (10) DAYS prior to the hearing, NOTICE of the filing of the petition
and of the date, time, and place of the above-scheduled hearing shall be given to Eric
Michael Berkheimer, the non-petitioning parent, and shall be published in two
newspapers of general circulation in Cumberland County or an adjoining county, one of
which may be the Cumberland County Law Journal, in accordance with 54 Pa.C.S. §
701 and C.C.R.P. 5. Proof of publication and service to the non-petitioning parent must
be filed with the Cumberland County Prothonotary prior to the above-scheduled hearing.
Petitioner failed to provide the current and any prior residence(s) of Petitioner, as
required by 54 Pa.C.S. § 701. The court is allowing leave for Petitioner to provide such
information at the hearing in the interest of judicial efficiency.
_BY
VI 14A _3d
�vgno0 GNVII 39WI713'
ThomaVAJ Placey C.P.J.
Distribution:
/Jane Adams, Esq. ^,uF1110 I y "
LL
IN RE: GABRIEL JOSEPH IN THE COURT OF COMMON PLEAS OF
RODGERS BERKHEIMER, CUMBERLAND COUNTY, PENNSYLVANIA
born 2/26/09 THE NINTH JUDICIAL DISTRICT
2013-6738 CIVIL TERM
IN RE: PETITION FOR CHANGE OF NAME
ORDER OF COURT
AND NOW, this 8th day of January, 2014, upon
consideration of the Petition for Change of Name, and following a
hearing, at which no objection was made, the petition is granted.
The child formerly known as Gabriel Joseph
Rodgers Berkheimer shall henceforth be known as Gabriel Joseph
Rodgers.
=y the ourt,
Thomas lr •lacey C. P.J.
✓Jane Adams, Esquire
17 W. South Street
Carlisle, PA 17013
For Petitioner
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