HomeMy WebLinkAbout96-02048
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VERIFICATION
I verIlY that the statements made in the foregoing Complaint are true and correct, I understand that
f.... atatements made herein are subject to the penalties of 18 PA C,S, 4904 relatina to unsworn
falal/lr.ation to authorities,
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Lijla Jlllieea Ro;nes
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LIJIA JULlSSA ROWLES,
Plalntlff
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
NOo ,/.. .J." I J' CML TERM
v,
JASON MICHAEL BERT,
Defendant
CML ACTION - LAW
CUSTODY
AFFIDAVIT SUPPORTING PETITION
FOR I.EAVE TO PROCEED IN FORMA PAUPERIS
1. I am the Plaintiff in the above matter and because of my financial condition am unable to
pay the fees sod costs of prosecuting the action,
2, I am unable to obtain funds from anyone. including my family and 88lloclates, to pay the
COllts of litigationo
3, I represent that the information below relating to my ability to pay the fees sod COllIII Ia
true and COlTcet:
a, Name: Lijis Ju1isM Rowles
Address:
25 West HlIJ'risburg Street, Dillsburg, PA 17019
Social Security Number:
085-60-9800
b, Employment: presently unemployed
C,
Other income within past 12 months:
Support Payments of t34&'monl.h ,
Other: WIC (Food Products)
if )(,'-1 tl.rl::t ;i:e-.;entry UILd1.1pk.1cd, ::t.1tP.
Date of last employment: N/A
Business or profession: None
Other self-employment: None
Interest: None
Dividends: None
Pension and IlIInuities: None
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Social Security benefits:
None
Support pe,yments: S346000/month
DilllbWty pe.yments: None
Unemployment compenl8tion and supplemental benenta: None
Workman's compelll8tion: None
Public M8istance: None
Other: None
Other contributions to household support: None
Spouse's Name: Mitchell Anthony Rowle. (Divorce ~'endln8>
If your spouse is employed, state Employer: United States Navy
Salary or wages per month: Unknown
_ Type of work: Internal Communications Technician
Contributions from children: None
e, Property owned
Cash: nominal
Checking Account: SO
Savings Account: '5
Certificates of Deposit: None
Real Estate (including home): None
Motor vehicle: Make: Year:
Cost: Amount Owed:
Stocks; bonds: None
Other: None
f. Debts and obligations
Mortgage: None
Rent: Sl89,OO/month
Loans:
Daycare:
8, Penolll dependent upon you for tiupport:
Children, If 1IIl,Y:
Kayla Igra.yme Rowles, Born January 29. 1992
MlIJ'iah IJayne Rowles, Born May 18. 1993
Brock LoIJlUl Bert, Born September 28, 1990
4, I underetand thllt I hIIve 1\ continuing obliglllion to inform the Court of improvement In
my nnanclal circumstances, which would permit me to pay the co.t. Incurred herein,
O. I verify thllt the .l.I\tement. IIlI\de In this Affidavit lIJ'e true and correct. I underetand thllt
false .l.I\tement. herein llI'e made .ubjL..t to tho pelllllUes uf l:l Pa. C.S, ~4904, relittlnll to URlIwom
falsification to authoritie.,
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LIJI:l JULISSA ROWLES, I IN THE COURT OF COMMON PLEAS OF
Plaintiff I CUMBERLAND COUNTY, PENNSYLVANIA
I
v. I CIVIL ACTION - LAW
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JASON MICHAEL BERT, . NO. 96 - 2048 CIVIL TERM
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Defendant I
. CIVIL ACTION - CUSTODY
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ORDER
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AND NOW, this Jt day of June, 1996, the Conciliator being
advisecLthat the parties have reached an agreement, the ConcJ.liator
relinquishes jurisdiction.
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