Civil Cover Sheet Page 3
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73. There are no judgments or decrees of like character of record against
Petitioner.
WHEREFORE, Petitioner respectfully requests this Court, pursuant to the Act of
December 16, 1982, P.L. 1309, No. 295, Section 2, 54 Pa. Cons. Stat. Section 702, for the
following:
a. To fix a hearing on this Petition;
b. To direct that notice be given of this Petition and hearing; and,
c. To enter a decree changing the Petitioner’s name from
___________________________ to ____________________________.
This Petition for Change of Name is respectfully submitted by:
____________________________________
(Please print name)
___________________________________
Signature of Petitioner
Date: ___________________
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