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IN THE DISTRICT COURT

THIRD JUDICIAL DISTICT, SHAWNEE COUNTY, KANSASDIVISION FOUR

IN THE MATTER OF

HALLECK G. RICHARDSON

AND; Case No. 96-D-217

CLAUDINE DOMBROWSKI___________________________Pursuant to K.S.A. CHAPTER 60

NOTICE OF ADDRESS CHANGE OF RESPONDENT

COMES NOW, Claudine Dombrowski, respondent, and gives notice of legal change of address

and contact information as follows below to take effect immediately upon filing this 9th

day of

March 2011.

IN SUPPORT,Respondent states and provides supporting documentation as follows:

1. Claudine M. Dombrowski is a certified Participant in Safe at Home, the KansasSecretary of States Address Confidentiality Program provided for victims of

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WHERFORE, Respondent has gi

effective on this 9th

day ofMarc

Respectfully Submitted,

Claudine Dombrowski-Date 3-0Mother/Respondent

P.O. Box 798, Topeka, KS 66601

* Phone (785) 274-9075

Attachment: State of Kans

Authorization

* Please make note of new c

en proper presentation of legal change of addre

2011.

9-2011

-0798

as Safe At Home Program Participant Program

Certification

ntact phone number: (785) 274-9075

ss and is

articipant

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NOTICE O

I, the undersigned hereby certify that

of the above and foregoing ; NOTICE

Clerk of the District Court, Judge DebKansas 66603, by facsimile in accordan

To: Clerk of the District CouFax (785) 291-4908

To: Domestic FilingsFax (785) 291-4911

And; sent a true and correct copy of the

Don Hoffman100 E. 9th Street

Topeka, Kansas 66612

ERTIFICATE OF SERVICE

ADDRESS CHANGE OF RESPONDENT

on the 9th day of March, 2011, served a true and

OF ADDRESS CHANGE OF RESPONDENT,

nham, and Domestic Filings, 200 SE 7th

Street,ce with Supreme Court Rule 119(b)(3).

rt To: Judge David DebenhamFax (785)291-4917

To: Tuck Duncan - Courtesy CopyFax (785) 233-5659

forgoing document, by U.S. Mail, postage prepai

Jill Dykes1243 SW Topeka Blvd.

Topeka, Kansas 66603

correct copy

with the

Topeka,

d to:

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State of KansasSafe At Home Program Participant

Program Participant Authorization Certificate

Claudine M. Dombrowski is here by certified as a Participant in Safe at Home, the Kansas addressconfidentiality program and is authorized (in accordance with K.S.A 75-451 et. seq.) to use the following

designated address:

Claudine M. Dombrowski #0210

POBox 798

Topeka, KS 66601-0798

Certification expires November 5, 2014 unless cancelled sooner pursuant to (K. S. A. 75-454).

Upon presentation of this certificate or the participant card, state and local agencies and the courts shall accept the

designated address when creating a new public record for the above listed individual. If you have any questions

regarding the Safe At Home Program or the valid use of the authorization card, please call (785) 296-3806.

~

~

Safe < It IlomeK"lUll..(

Kim