IN THE DISTRICT COURT

THIRD JUDICIAL DISTICT, SHAWNEE COUNTY, KANSAS

DIVISION 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 Kansas

Secretary of States’ Address Confidentiality Program provided for victims of

Domestic Violence and she is authorized (in accordance with K.S.A 75-451 et. seq.)

to use the following designated address:

CLAUDINE DOMBROWSKI #0210

P.O. BOX 798
TOPEKA, KS 66601-0798

2. In accordance with K.S.A 75-451 et. seq. 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.

3. Certification is attached and presented to the court and for the court record.
WHERFORE, Respondent has given proper presentation of legal change of address and is
th
effective on this 9 day of March 2011.

Respectfully Submitted,

Claudine Dombrowski-Date 3-09

09-2011
Mother/Respondent
P.O. Box 798, Topeka, KS 66601
66601-0798
* Phone (785) 274-9075

Attachment: State of Kansas Safe At Home Program Participant Program Participant

Authorization Certification

* Please make note of new contact phone number: (785) 274-9075

CERTIFICATE OF SERVICE FOLLOWS

 CERTIFICATE OF SERVICE

NOTICE OF ADDRESS CHANGE OF RESPONDENT

I, the undersigned hereby certify that on the 9th day of March, 2011,, served a true and correct copy
of the above and foregoing ; NOTICE OF ADDRESS CHANGE OF RESPONDENT RESPONDENT,, with the
Clerk of the District Court, Judge Debenham, and Domestic Filings, 200 SE 7th Street, Topeka,
Kansas 66603, by facsimile in accordance with Supreme Court Rule 119(b)(3)
119(b)(3).

To: Clerk of the District Court To: Judge David Debenham

Fax (785) 291-4908 Fax (785) 291-4917

To: Domestic Filings To: Tuck Duncan - Courtesy Copy

Fax (785) 291-4911 Fax (785) 233-5659

And; sent a true and correct copy of the forgoing document, by U.S. Mail, postage prepaid to:

Don Hoffman Jill Dykes

100 E. 9th Street 1243 SW Topeka Blvd.
Topeka, Kansas 66612 Topeka, Kansas 66603

Claudine Dombrowski date: 3-09

09-2011
Mother/Respondent
P.O. Box 798, Topeka, KS 66601--0798
* Phone (785) 274-9075

Cc: Kris W. Kobach, Kansas Secretary of State, Safe at Home Address Confidentiality Program
Dorthy Halley, Kansas Attorney General Office, Victims Rights
Joyce Grover, Kansas Coalition Against Domestic Violence
Sam Brownback, Kansas Governor
 ,
State of Kansas
Safe At Home Program Participant
Program Participant Authorization Certificate

Claudine M. Dombrowski is here by certified as a Participant in Safe at Home, the Kansas address
confidentiality 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.

~
Kim
~
Safe <It Ilome
K"lUll..(