HomeMy WebLinkAbout15-0256 IN THE COURT OF COMMON PLEAS OF Cumberland COUNTY, PENNSYLVANIA
CIVIL DIVISION -LAW
IN THE MATTER OF
PETITION FOR CHANGE OF NAME OF ,-
Michael Thomas Pavusik N0.
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PETITION FOR CHANGE OF NAME` ' -"
Petitioner Michael Thomas Pavusik , requests that this Court order a change of tie ;�D w*
petitioner's name, pursuant to 54 Pa. Cons. Stat. Section 701, et sea., and in support thereof
makes the following the averments:
1. The petitioner was born on 01/26/1990 and is currently 24
years old.
2. During the five years preceding the filing of this petition, the petitioner has resided
in the following places:
DATE ADDRESSES
12/21/2014 - Present _ 707 Jonathan Court, Mechanicsburg, Pennsylvania 17055
05/31/2014 - 12/21/2014 115 South Street, Harrisburg, Pennsylvania 17101
02/02/2002 - 05/31/2014 3603 Golfview Drive, Mechanicsburg, Pennsylvania 17050
3. There are no judgments or decrees pending against the petitioner.
4. The Petitioner requests that his/her name be changed from Michael Thomas Pavusik to
Michael Thomas Westwick
5. The reasons for the requested change of name are Due to the facial paralysis
that I experienced in 200!41 find it difficult to pronounce my own last name.
6. The Petitioner has not been convicted of a felony.
WHEREFORE, the petitioner respectfully requests that this Court enter an Order
changing his/her name from Michael Thomas Pavusik to Michael Thomas Westwick
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Petitioner
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VERIFICATION
1, Michael Thomas Pavusik , 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.
§ 4904 relating to unsworn fabrication to authorities, which provides that if I knowingly
make false averments, I may be subject to criminal penalties.
Date:
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(Sign Your Current Name)