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NINTH JUDICIAL DISTRICT OF PENNSYLVANIA
COURT OF COMMON PLEAS OF CUMBERLAND COUNT)E"'I'S ZJN -9 P11 2: [!"','
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TRIAL DIVISION-CIVIL C U i"IL3 E R L A N*D C r;U
IN RE: CHANGE OF NAME
tele FILE No.
No�unonnj
PETITION FOR NAME CHANGE
The Petitioner,Nicole Lee Notarianni,request that this Court order a change of name for,Nicole Lee
Notarianni,and in support thereof represents as follows:
1. Petitioner is an adult individual,whose date of birth is March 30, 1971,and who presently
resides as 6285 Appaloosa Drive,Mechanicsburg,PA 17050, in the County of Cumberland.
2. Petitioner desires this name change for the following reasons:
a. Petitioner was married on September 27,2014 to Matthew W.Crocker.
b. Petitioner desires to replace middle name of Lee with maiden name of Notarianni and
replace surname with Crocker
c. Petitioner has no male siblings and desires to maintain maiden name in formal name
in order to preserve name.
3. Petitioner is a citizen of the United States of America.
4. There are no judgments of decrees against the petitioner.
5. WHEREOF,Petitioner respectfully requests that this Court enter an Order changing the
Petitioner from Nicole Lee Notarianni to Nicole Notarianni Crocker. -7
1A
Respectfully Submitted, PP
C'.-S-A
Veifitioner C4
Telephone: 812-453-5340
/5P
NINTH JUDICIAL DISTRICT OF PENNSYLVANIA
COURT OF COMMON PLEAS OF CUMBERLAND COUNTY
TRIAL DIVISION-CIVIL;
IN THE MATTER OF TERM,
PETITION FOR CHANGE OF
NAME OF
NO. �.0 l S 6 Q U G'v. ' �C!w•
VERIFICATION
I, 9 t C'�i 9 ll�a�-�,�jr��(� � Petitioner herein,hereby verify that the
information contained in the Petition for Change of Name is true and correct to the best of
my knowledge, information and belief.. This verification is made subject to the penalties of 18
Pa. C.S. §4904 relating to unsworn falsification to authorities.
Petitioner