HomeMy WebLinkAbout02-42331N THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
1N RE: NAME CHANGE OF :
ALEXIS DOMINIQUE SMITH TO :
ALEXIS DOMINIQUE WILLIAMS:
NO.~ CIVIL TERM
PETITION FOR NAME CHANGE
AND NOW comes Petitioner, ALEXIS DOMINIQUE SMITH, by and through
her mother, LAUREN SMITH WILLIAMS, and her step-father, ALLAN S. WILLIAMS,
who make the following averments in support of this Petition for Name Change pursuant
to 54 Pa.C.S. {}702 pertaining to judicial change of name for minor child.
1. Alexis Dominique Smith, a minor child, with a date of birth of 28 September
1997, is the daughter of Lauren Smith Williams. Please see Birth Certificate attached
hereto, marked as Exhibit "A" and incorporated herein by reference.
2. Alexis Dominique Smith resides with her mother and step father at 412-B
South High Street, Mechanicsburg, Cumberland County, PA 17055.
3. The Petitioner's natural parents were never married and the father has been
estranged since before her birth.
4. Paternity has never been conclusively established.
5. Alexis Smith's Social Security Numbar is 161-78-1668. See Social Security
Card attached hereto, marked as Exhibit "B" and incorporated herein by reference.
6. Alexis has resided with her mother since birth; she has never known her
natural father.
7. The father has refused any contact with her or acknowledgment of her birth.
d. Alexis, intellectually and rationally, understands the significance of
changing her name to that of her family.
e. There is no fraudulent purpose behind this request for a name change.
16. Petitioner has been fingerprinted in accordance with thejudicial change of
name requirements at the Cumberland County Sheriff's Office and her fingerprint
card is attached hereto as Exhibit "C".
WHEREFORE, Petitioner prays that a hearing be scheduled to address the
issues raised herein.
Respectfully submitted,
Alexis Dominique Smit~,,
and through her mother,//~JX4~'q .~"gffl ~
Lauren Smith Williams
and her stepfather/'~, d~.~ ~
Allan S. Williams
412-B South High Street
Mechanicsburg, PA 17055
(717) 697-3003
VERIFICATION
I verify that the statements made in the foregoing document are tree and correct to
the best of my knowledge, information, and belief. I understand that false
statements herein are made subject to the penalties of 18 Pa. C.S. {}4904 relating
to unswom falsification to authorities.
Lauren Smith Williams
EXHIBIT A
COUNTY OF
BIRTH
DATE
DAUPH ! N ~SSUEB
05~650-~7
10-14-c/7
10-29-97
NAME SEX FEMALE
ALEXIS DOMINIQUE SMITH
FATHERS NAME
INFORMATION NOT RECORDED
MOTHERS MAIDEN NAME
LAUREN VANESSA SMITH
ALEXIS DOMINIQUE SMITH
C/O 2124 WENTWORTH DR
CAMP HELL PA 17011
2395189
EXHIBIT B
APPLICANT I/Y L"AWBLANK
'~'""~ C-k'~
~ESIDENCE OF PERSON FINGERPRINTED
~ 4205
~Mitchem Brandon
O~HI~R
NAME C~ANGE
TYPE OR PRINT ALL INFORMATION IN BLACK
LAST NAME NAM FiRST NAME
~ILLIAMB
3,t.'~'~'T q DOMINIQUE
ALIASES AK~A O
R
CITIZENSHIP CT~
FBI NO
MIDDLE NAME
LEAVE BLANK
09 28 1997
LEAVE I
I R THUMB
08113385 #ng067 16:20:11
~ml 5701LD
~9 20020903~ =28 ~
EXHIBIT C
IN THE COURT OF COMMON [;LEAS
CUMBERLAND COUNTY, PENNSYLVANIA
IN RE: NAME CHANGE OF
ALEXIS DOMINIQUE SMITH TO
ALEXIS DOMINIQUE WILLIAMS:
NO. 01t [' q,,~33 CIVIL TERM
ORDER OF COURT
AND NOW, thi ay o 20 [ upon consideration of
Petitioner's iudicial reauest of name change of minor child, IT IS HEREBY ORDERED
DECI~EED that ~ hearing is schedu~d for~,~ ~ ~. ~ ~ 2002, at
/-'A'N~ ~OO o-' clock ~.m. in courtroom ~ at the Cum[~erland County Courthouse, One
Courthouse Square, Carlisle, PA 17013. In the meantime, the Petition for Name Change
shall be advertised in The Cumberland County Law Journal and The Patriot News. Proof
of Publication shall be forwarded to this Court on or before the date scheduled for the
above hearing.
BY THE
Distribution:
Prothonotary's Office
Petitioners:
Alexis, Lauren & Allan Williams
512-B South High Street
Mechanicsburg, PA 17055
(717) 697-3003
9%-02