On January 03, 2024 a
Party Statement
was filed
involving a dispute between
Cassandra Bielby,
and
for Other Matters - Name Change/Sex Designation Change
in the District Court of Madison County.
Preview
FILED: MADISON COUNTY CLERK 01/03/2024 09:18 AM INDEX NO. EF2024-1014
NYSCEF DOC. NO. 2 RECEIVED NYSCEF: 01/03/2024
STATE OF NEW YORK
COUNTY COURT COUNTY OF MADISON
In the Matter of the Application of Lynnsey M. Eddy,
by her parent for leave to assume another name AFFIDAVIT
Index No.:
STATE OF NEW YORK)
COUNTY OF MADISON) ss.:
Dustin Eddy, being duly sworn, deposes and says:
1. That I am the natural father of Lynnsey Mae Eddy (dob: 12/19/08). I reside at 106 N. Court
Street, Canastota, New York.
2. I am aware that my daughter, Lynnsey, had a very close relationship with her late grandfather,
Daniel Cerio.
3. I am also aware of the fact that for the past two years, Lynnsey has wanted to change her name
to add the surname Cerio. I have no objections to my daughter having the name Lynnsey Mae Eddy Cerio.
4. I consent to the name change proposed.
Dustin Eddy
Sworn to before me this
day o 3.
Notary Public
/ STATE
OF NEW YORK
NOTARY PUBUC Î Ê
5 \ 01BA4991349
1 of 1
Preview
FILED: MADISON COUNTY CLERK 01/03/2024 09:18 AM INDEX NO. EF2024-1014 NYSCEF DOC. NO. 2 RECEIVED NYSCEF: 01/03/2024 STATE OF NEW YORK COUNTY COURT COUNTY OF MADISON In the Matter of the Application of Lynnsey M. Eddy, by her parent for leave to assume another name AFFIDAVIT Index No.: STATE OF NEW YORK) COUNTY OF MADISON) ss.: Dustin Eddy, being duly sworn, deposes and says: 1. That I am the natural father of Lynnsey Mae Eddy (dob: 12/19/08). I reside at 106 N. Court Street, Canastota, New York. 2. I am aware that my daughter, Lynnsey, had a very close relationship with her late grandfather, Daniel Cerio. 3. I am also aware of the fact that for the past two years, Lynnsey has wanted to change her name to add the surname Cerio. I have no objections to my daughter having the name Lynnsey Mae Eddy Cerio. 4. I consent to the name change proposed. Dustin Eddy Sworn to before me this day o 3. Notary Public / STATE OF NEW YORK NOTARY PUBUC Î Ê 5 \ 01BA4991349 1 of 1