On January 03, 2024 a
Stipulation,Agreement
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. 5 RECEIVED NYSCEF: 01/03/2024
STATE OF NEW YORK
SUPREME COURT COUNTY OF MADISON
In the Matter of the Application of Lynnsey M.
Eddy, by her parent for leave to assume
another name STIPULATION
Index No.:
IT IS HEREBY AGREED AND STIPULATED between Cassandra Bielby, the natural mother of
Lynnsey Mae Eddy, and Dustin Eddy, the natural father of the child, that an order may be entered granting
leave for the child to assume the name of Lynnsey Mae Eddy Cerio in the place of that of Lynnsey Mae
Eddy.
Datedh c m Lyr 9 , 2023
Ñ RA BIELBY DUSTIÔY
Natural mother/petitioner Natural father
MARIA J. CERI
Attomey for Petitio r
STATE OF NEW YORK)
COUNTY OF MADISON) ss.:
On °2 , 2023, before the appeared CASSANDRA
me, undersigned, personally
BIELBY, personally known to me or proved to me on the basis of satisfactory evidence to be the individual
whose name is subscribed to the within instrument and acknowledged to me that she executed the same in
her capacity, and that by her signature on the instrument, the individual executed the instrument.
Notary Public
O c
NOTAR UEUC
cour y/
018A4991349 /
1 of 2
FILED: MADISON COUNTY CLERK 01/03/2024 09:18 AM INDEX NO. EF2024-1014
NYSCEF DOC. NO. 5 RECEIVED NYSCEF: 01/03/2024
STATE OF NEW YORK)
COUNTY OF MADISON) ss.:
On /c2 7 , 2023, before me, the undersigned, personally appeared DUSTIN EDDY,
personally known to me or proved to me on the basis of satisfactory evidence to be the individual whose name
is subscribed to the within instrument and acknowledged to me that he executed the same in his capacity, and
that by his signature on the instrument, the individual executed the instrument.
""T""' abo r  /3nn /cut
Notary Public
OF NEW YORK
NOTARY PUBUC
01BA4991349 /
2 of 2
Preview
FILED: MADISON COUNTY CLERK 01/03/2024 09:18 AM INDEX NO. EF2024-1014 NYSCEF DOC. NO. 5 RECEIVED NYSCEF: 01/03/2024 STATE OF NEW YORK SUPREME COURT COUNTY OF MADISON In the Matter of the Application of Lynnsey M. Eddy, by her parent for leave to assume another name STIPULATION Index No.: IT IS HEREBY AGREED AND STIPULATED between Cassandra Bielby, the natural mother of Lynnsey Mae Eddy, and Dustin Eddy, the natural father of the child, that an order may be entered granting leave for the child to assume the name of Lynnsey Mae Eddy Cerio in the place of that of Lynnsey Mae Eddy. Datedh c m Lyr 9 , 2023 Ñ RA BIELBY DUSTIÔY Natural mother/petitioner Natural father MARIA J. CERI Attomey for Petitio r STATE OF NEW YORK) COUNTY OF MADISON) ss.: On °2 , 2023, before the appeared CASSANDRA me, undersigned, personally BIELBY, personally known to me or proved to me on the basis of satisfactory evidence to be the individual whose name is subscribed to the within instrument and acknowledged to me that she executed the same in her capacity, and that by her signature on the instrument, the individual executed the instrument. Notary Public O c NOTAR UEUC cour y/ 018A4991349 / 1 of 2 FILED: MADISON COUNTY CLERK 01/03/2024 09:18 AM INDEX NO. EF2024-1014 NYSCEF DOC. NO. 5 RECEIVED NYSCEF: 01/03/2024 STATE OF NEW YORK) COUNTY OF MADISON) ss.: On /c2 7 , 2023, before me, the undersigned, personally appeared DUSTIN EDDY, personally known to me or proved to me on the basis of satisfactory evidence to be the individual whose name is subscribed to the within instrument and acknowledged to me that he executed the same in his capacity, and that by his signature on the instrument, the individual executed the instrument. ""T""' abo r  /3nn /cut Notary Public OF NEW YORK NOTARY PUBUC 01BA4991349 / 2 of 2