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Home My WebLink About05-3138 :IN THE COURT OF COMMON PLEAS OF :CUMBERLAND COUNTY, PENNSYLVANIA IN RE: A VA NICOLE GIL :CIVIL ACTION - LAW :NAME CHANGE a5 - 31:3~ :NO. CIVIL TERM PETITION FOR NAME CHANGE PURSUANT TO 54 Pa. C.S. 11701 The Petitioner, Janet L. Stelz, by her attorneys, the Family Law Clinic, hereby petitions this Honorable Court to enter a decree changing her minor daughter's name from Ava Nicole Gil to Ava Nicole Stelz, and respectfully represents that: I. The Petitioner is Janet L. Stelz, who lives at 100 Pin Oak Lane, Shippensburg, Cumberland County, Pennsylvania. 2. Petitioner is the biological mother of Ava Nicole Gil (hereinafter "child"), who was born on September 5, 2004 in Middletown, Orange County, New York. A true copy of Ava's birth certificate is attached as Exhibit "A" and is incorporated herein by reference. 3. Child's social security number is 077-94-1504. 4. Child's biological father is Joseph Robert Gil (hereinafter "Father"), whose last known address is 503 Circle Lane, Newburg, Orange County, New York. 5. Petitioner and Father never married. 6. Petitioner avers that it is in the best interest of Ava Nicole Gil to have her name changed to Ava Nicole Stelz for the following reasons: a) Petitioner has had sole custody of Child since they left New York and moved to Pennsylvania on November 6, 2004, two months after her birth. b) Father has had no contact with Child or Petitioner since November 6, 2004. c) The Domestic Relations Office has been unable to locate Father in an effort to have him pay child support. d) Petitioner feels that it is important for Child to have the family surname ofthe only family she has known, especially during the early school years when this identity is crucial. 7. Since November 6, 2004, Petitioner and Child have lived at their current address, 100 Pin Oak Lane, Shippensburg, Cumberland County, Pennsylvania, and Father is aware of this address. 8. There are no judgments, liens, decrees, or the like against A va Nicole Gil or Ava Nicole Stelz. WHEREFORE, Petitioner prays that the Court: a) Set a time and place for a hearing on the above-captioned matter; b) Direct Petitioner to serve this Petition and the attached Order on Joseph Robert Gil, the biological father ofthe child, at his last known address, via United States mail, certified, restricted delivery, return receipt requested, postage prepaid and by regular first class mail; c) Direct that notice in the form set forth in Exhibit "B," attached hereto, be published of the filing of this Petition and of any hearing once in the Carlisle Sentinel and the Cumberland Law Journal; d) After said hearing, enter an Order changing the name of Ava Nicole Gil to Ava Nicole Stelz; and e) Grant such other relief as the Court deems just. ~f6EG~ ~ Date: LUCY J ANNE ONALD-FOX Supervising Attorneys F AMIL Y LAW CLINIC 45 North Pitt Street Carlisle, P A 17013 (717) 243-2968 3501 New York State Department of Health Recorded District CERTIFICATE OF LIVE BI RTH Register Number ()2-() 1A.Name: AVA First Middle NICOLE 28. Hour: 10:39 AM / State File Number: , , " I- Z < II. 2!: 1 B. Medical Record No.: 397342 111111111111111111111111111111111I111111111111111111111111111111111111111111111111111 131-2004-00086288 Last GIL 4A_ Birth Is: Single 48. If Not Single, Birth Is: 6A. Facility Name: (Address, if Place of Birth is Other than Hospital/Birthing Center) Orange Regional Medical Ctr-Middletown Campus 5. Place of Birth: Hospital 68. Locality of Birth: City of Middletown 7 A-1. Name: First JAN ET Middle LYNN 6G. County of Birth: Orange ClJrrent Last Name STELZ 7B. Dale of Birth: 05/09/1973 7e. City & Slate of Birth: (Country, ifnot U.S.A.) QUEENS, New York 7 A-2. Maiden last Name: STELZ II: W :J: I- o :;; 8A. Residence, Stale: (Country, if nof US.A.) New York BG. Locality: Town of Wallkill BE. Street and Number of Residence: 903 WALLKILL Ave aG. Mailing Address: 903 WALLKILL Ave, Wailkili , NY II: w :J: I- If 9A. Name: First Middle ROBERT JOSEPH 9B. Date of Birtl1: 06/19/1969 9C. City& Stale of Birth: (Country, ifnotU.S.A.j AMITYVILLE, New York I- Z < Q Z W l- I- < cl1i\d is lrue 10 the best of my knowledge and belief. Title: 10A. I certify that the slated inf r Signature .. 10C. Name of Certifier, If ttendant" 10E. Attendant's Name: ESTLER KiMBERLY ANNE ~ -Ie 12. Information Added or Corrected: Item No. Date of Correl:/ion Authorization Original information c;;- o o N OJ 2- ill M '" '" i. o o I EXHIBIT It 88. County. (Terr. or Prov., if not USA) Orange Inside CityNillage Limit? 8F. Zip Code: 12589 8H. Zip Code: 12589 Last GIL Title: M.D. 10F-1. NYS License Number: (AllelldanQ 21 9235 .~ VERIFICATION I hereby verify that the statements made in the foregoing Petition for Name Change are true and correct, to the best of my knowledge, information, and belief. I understand making a false statement would subject me to the penalties of 18 Pa.C.S. Section 4904, relating to unsworn falsification to authorities. Date: 0 ....., ~ ~ ""~ '- ~::; ...,.- ~ "i!..,., rl1E -0"4 ~;:) 'L I..-:,~C) ~:-r~ ~'~ :)?"j >.,':r-n <~-4 -r.,., '-b :-< -J -n r:~ ...., \~\ \\ c : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA IN RE: AVA NICOLE GIL : CIVIL ACTION-LAW : NAME CHANGE :NO. 05- 3/10 CIVILTERM PRAECIPE TO PROCEED IN FORMA PAUPERIS Kindly allow Petitioner, Janet L. Stelz, to proceed in forma pauperis. The Family Law Clinic, attorneys for the party proceeding in forma pauperis, certifies that we believe the party is unable to pay the costs and that we are providing free legal service to the party. Date (o! ~ I() J BRENDA COPP Certified Legal Intern r&U&;t UCY 0 TON-WALSH ANNE (<\CDONALD-FOX Supervising Attorneys FAMILY LAW CLINIC 45 North Pitt Street Carlisle, P A 17013 (717) 243-2968 .....' c;~::> C' ",,1 '- S::' ,<,',0.- - -' --C ~:'~: r:3 .- o -.. .-\ :t. -r\ rnr:: ...u"1fD ,'<,Q .'J1b i~~~~\ ,;... '~2 - - .....A.., .. IN RE: AVA NICOLE GIL : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA : 05-3138 CIVIL TERM ORDER OF COURT AND NOW, this ~ day of June, 2005, the petition to proceed in forma pauperis is granted to the extent that petitioner is relieved of paying the filing fee. Brenda Coppede, Certified Legal Intern Lucy Johnston-Walsh, Esquire Anne MacDonald-Fox, Esquire Supervising Attorneys :sal vP'IR. G; \ /!Sic..K\oson -Sc.hoCll 0 t Lo..uJ ~ ..,.. ~ j:~ , . '~~~ ~~~~~::-':. ~~'o.... ~tU '.~:C- .- tl;- o r- c-l .' - - c-l \,.,n @ i;-.J >.::)3 .. '~,- ~"~/~~ "~bC.J -;)D-< ,;;; b - RECEIVED JUN 20 Z005:r' :IN THE COURT OF COMMON PLEAS OF :CUMBERLAND COUNTY, PENNSYLVANIA IN RE: A VA NICOLE GIL :CIVIL ACTION - LA W :NAME CHANGE : OS-....J/3'1\ :NO. CIVIL TERM ORDER OF COURT AND NOW, this L day of Cld "" 0 , 2005, upon consideration ofthe foregoing Petition, it is ordered that: ~ a) A hearing will be held on the 'J..qV day ofC\ "" I'ft l, 2005, at 'b . '1<;" o'clock, c... .m. in Courtroom ~ of the Cumberland Cou~ouse, 4th Floor, Carlisle, Pennsylvania. b) Petitioner is to serve the Petition for Name Change and this Order on Joseph Robert Gil, via United States mail, certified, restricted delivery, return receipt requested, postage prepaid, and regular first class mail. c) Petitioner is to publish the notice in the form set forth in Exhibit "B" to the Petition, once in the Carlisle Sentinel and the Cumberland Law J s r ired by Cumberland County Local Rule 5. :>0' r- i"= c::: l'" ~~ ;;:: c) <t_ "'..- ~r;:: C) i-:-- :) ~!:: N 7~_ ..:::: U ~..,*' ~i~ ~._'" ::5 " I ...c_ t: ci:l 1.1-1 --, 0- ,r' "'''> 5 '='-~'::) '3 <;:';J (.) ,.... - INRE: A V A NICOLE GIL : IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW : NAME CHANGE : NOof.3138 CIVIL TERM ORDER OF COURT AND NOW, this ~ day of ~_, 2005, upon consideration of the Petition for a Name Change regarding Ava Nicole Gil, date of birth September 5, 2004, place of birth, Middletown, New Yark, and after a hearing on the matter, it is ordered and directed that the name of the subject child be changed from A va Nicole Gil to Ava Nicole Stelz. The New York State Department of Health, Vital Records Section is hereby requested and directed to issue a new birth certificate changing the name of Ava Nicole Gil to Ava Nicole Stelz. / J. COr!':!l V(t'l rD Ava. Nlcgle SIe/'l C2 ~~ ....' .g 2P ;?, 2,") ~ Sf, -' -(I ~I"'" -00.:.\ ~". '-( ';F.:.:.,:"~\~\ j:~, , :;2.> (:) :::-:'"~ ~ q; u..., .-