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( \v ,\) C '. II (I h' C,,) II
IN THE COUfH OF CCJt.\MON f'LEI,S OF YORK COUNTY, PENNSYLVANlfl
..Pa.ki~i.o...JC\l.;)~ot(..Y1_.
Plaintiff
versus
NO """""''''1'
( ,(l:Q"...Td' I
Il{ IjlJ ~.hIR5.~/),(\j or
PRO SE
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CIVIL fICTION LAW ~;: '"0
PROTECTION mar,., ABlJ~ :::J:
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Defendant
~.QJ.LG E TO QJ;fftlQ
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'I YOU HAVE BEEN SUED IN COURT. Th\1 Plainllff is the persoh suing on behnlf
of the abused person(s). Attached is a copy of the Petition which indicates the relief
! the Plaintiff is requesting, Also included In the Petition me Plallltiffs reasons for these
requests,
YOlI must appear attha hearing on the ~L .rt day of ~lJ~ rnbo- .'
19:J.!J. atq " 00 AM,~ In COllrt Room No ..5__ of the Court of Common Pleas
, of York County, located at 28 East Market Street. York, PA
If you do not appear at the he;;lrIng at the time and place as set forth above, the
Order requested by Plaintiff may be granted In your absence, and you may lose moncy
or property fights or oilier flglltS IlllfJortont to you, andlor a bench warrant may be
issued directing the Sheriff to bring you into Court
If a copy of a TEMPORARY ORDER is attadlcd, YOll must obey it until the
hearing. If YOll do not obey It, the police can arrest you and YOlI may be charged wllh
indirect Criminal Contempt
YOU SHOULD TAKE THIS PAPER TO YOUR LAWYEf~ AT O~.E. YOU HAVE
A RIGHT TO HAVE AN ATIORNEY REPRESENT YOU AT THE HEARING, IF YOU
DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE GO TO OR TELEPHONE
THE OFFICE SET FORTH BELOW TO FIND OUT WHEF{E YOU MAY GET LEGAL
HELP,
L.AWYER REFERRAL SERVICE
of the York CO\JI1ty Bar Association
t 37 Easl Market Street
York,PA 17401
(717) 771-9361
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_.._, 4._' .'.._..,___.._.._________. .
IN 1111 CUl.II{ Illl l:or,Ih10N PI [,\S OF YORK COUNTY, PENNSYLVANIA
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NO
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qv, JJJ (Y5/110--oF
PRO SE
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CIVIL ACTION LAW n ~
PROTECTION FROM AB~ ::
~~\ N
, PEJlrION.EQB.P..BQ.TJ;gJ.Q1tFROM.lI~. -rJ'l? ~
I :P\7i r:-i
'; 0 Till:: IIONCJr\ALJl.E JUDGE OF SAID COURT: 1'1 r
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1, My tHH1l0 15 1Jo..tr.!.c.iJl.._~J;)Odk ~,
I Uflltilo Plulntlff In tlllG cnse I 0111 an adult individual.
tti'~r~\\e\1 VJoot,e.n...n
lJuhJlldllnt I
(. ( ) llivo 01.9 5.ft, Ctodo.r...s.::Bi)~:f.w.\S~" rr\{]> A \l33'}
Streot Address ~ty
Fq~r.ii~Y",L'H__"_U__'(a_cJs____., Pennsylvania .-11339 '
Townsillp County Zip Code
em ( ) Ilivn Inll1ls County ot .3n undisclosed address for I11Y protection,
3. I 0111 IllIng tills Petition for tr.Jl11porary and final protection Orders pursuant to
1110 Protoction Frcm Abuse Act 23 Pa,C,S,A. !j6101 et seq, I al11 seeking relief as
(~~~~\I~II~ls~~t~6e~~~WI~~S~ name(s) Is \{~ \l1r) _u.Jo~te.n -+ ,
" () The nlJus"d person(s) resides at ..-9.s~_.c.ds..r.: oS 1<. d .
F," qt~eet Address
\..e.wi.Gbe.r(',..I____.u_u~~..f..~_..___r'OJ:.k I '7~_,
City Township County Zip Code
Pennsylvania with .._.....
(Name and relationsllip to the abused person of adult co-resident).
OR ( ) The abused person(s) is living In this County at an undisclosed address
for hls/her/tlleir protection.
,
: .... ... :~::P~':O~::'~":~':~:I:'~'~",~",,:~. .~. -.~. b~~~i~~~bT
the Defendant I'Iho resl(jes at. '151<L~o..r.s~.):\d. H~.f.\.iJJ:S~b.. tt_y.____.
I ~tr,eet Address City
.ro.'II"' ~i e.1J__ __ __ ~_'{tlSJ{_n__.. H'_m.. Pennsylvania .lJ.3.'3~
I Township r:;Ollllty Zip Code
6 T11e Defendant's Social secur.ltl..llUmber.ls ,....... .._______._.___..
The Defendant's (jate of birth is 'dJ.L-Y -:,yj. n. ..._... __
7. The 0 'fendant IS .._.B.l.,J_?b,g..!\d........._________. (state
relationship to abused person(s). such as husband or former husband, sexual/Intimate
r;artner, house l11"te, child, SOil or daugrller, etc ).
8. The Defendant works at ...n.F.:~Sj~~_ S.o.nJ~1
<V Name of Employer
located atC. o..r.1.sJ.e_~i~.~_., ..\':'l.e..c..hClOLc.sb..r..a..
Pennsylval1la. CJ
'\' a..__,
9. ( ) The residence of the abused person(s) from Wllich I am asking the Court
to exclude ....J.t1e. Defendant J is owned (rented) In the name of
.f..k!'.k.... ~....Y.a.t.r:i.c.Lo...~""OO.M.n.. -
OR ( ) I cannot reveal the name(s) of the owner(s) or renter(s) of the residence
from which I [\111 asking the COllrt to ,"xclude the Odendant for the name(s} will disclose
the whereabouts of tile abused person(s} Which must be kept confidential for
her/his/their protection.
10. The facts of tile most recent incident of abuse arc as follows: (Please write
a brief description of the inCident Including stlOves, kicks or blows inflicted, weapons
used, threats made, Instances of stalking, Injuries sustained, medical or 110spit<J1
treatment necessary, if any.) . I 'T'J I
Ii 5 ~ Ce.cI4.rS NJ
Date ..\.tg.:..!:l~_..__ nn. Tll11e S:Q,Q._.(ii"Il1@ Location _J,.~\!J\.~b.e.rf_Y_'j),B.
~\} \\ \l~'oo.nA_w.o..,s_d.LU1\~.':t~Afl...u.p:s~~-becAY~e~.~~~ +. +
~1\C-\- uri l"\~e..I\OU)l.1"\ Ro..r.-ac..e..r~e.~ n~e 1I1'30'~. He. %'
~!la..m...s.\t.e,~;J:' ta-t>~~e'J..~.he...J:~.r;.c~-9.~ r, rc... 4 ..:Wa.k-f'I.u.:t_-
So~ ceJE...r~ %.0.: ~uC'(\;d-~r(Jwr) 4 un, Me 11ftI' 'T'Y\~
, 'n .se..Ile.nLL1:\M.~.~~.~\\-h~.\,;~.c~\f.r:.i--~-";c..~J.. ~.-
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'Y.:Jo.~\1.. \wt"+E:, ~.\Je.t"'ll\ '5~(\~'t!. ,-\."~ ~..., ~a..~'(>e.I\e.A .'
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,,",reoJel\ me. -\-0 cad ~I,( upe.~(l" sit :t" \(MW uJhd.:\ UJa:.s~od-d'
~()~ me.,\a\d ~Ie.. -to ~u Lt ~or~~ro~r:es t ';1:.v.Je.l1t.lJfH:it~\r,s
'do- 'ne. c.a.Mc;- ~e.r l"l'\~ ,a&ta..N\ 5 "'ic\(ir'l~ VY\~ ,:B'-;\',\-Inr-I'l !
I ~~l ~ l' ,\"'e.\D fJ.J;\d'r'e.. ,. Wls\ c' '0'\ U. \e..(-\-~Qt::l1'u Coq A'\p,\etelll
,000("OIJII0 '* 5'To.r~ \<.\~k\"Sl" 1'I'\e.. ~a.\O), 'th~n "'~ ,,\"lAJis\ed'
. 'ft\u, s;a('*. o.a.q,Ir\~Mu.l\I"I,,'-'.;t.~~ ~; ~~no.bkms t:t._w~~\
;~ ~ w~s ~O\nc~ -\-0 'alredl'. M ~-~ ~t.:l.60.~h~~r- ~A.\ e
'\ \ \ . 11 1 tlC Dt:fc!lldallt has physlcllly ,luused ll1e airel/or th'li Illcoh'lpctellt adull
i dfid/cr III,n"l didc:rell(len) III tile p:lsl '1 Ill: (o'loWIII(I all! SOIn" cx,lIl1ples or P,lst
Llbu~t'.'0 c0nd..Jct rL)(!s({IL(' If, l'ri(:( ~:~!';(. cf tl;L n:cst r(lC0r~t ~lfl':j/cr Inust serioLls
IlIlcldellts of past 1-)11'yslcal "L\I~l! ~)t;ll,' all ,1JlPIO>:ilnate date (or (~acll illcident )
· ':iU~~~t&~\\~~~~S;~~~ig\-.h';;J~ <\. ~~f.
I _,If.L\!~~~\.t\dJ~~ou &top- i L+..-rO~. _YY\~h~' 1iU-~. .-" bl
! \ 1\ 'O€.:hw E'.e.n ~~e.m 0.,\(\. (Y\ 'S.... no..s ee. J'\ L(lera.
:ab\J.se:d__x",{)~.t 01h~ ~i1~ ~('"~ ~is..lo.; .nt.L_'.._.___
i ~"."'"~c.. -"'1\0. . ""'kd"UIl- ,,\~C-_W...Lfu.La""c
: ,,:co~,rp"".- o&~~e.~~~Q_r;'~s a.1-~~~~\~n'~~~
Ct ~e.\ l" sr~~~ Q
C~l,J..f5...~OhmlJ..\jl)s.b a..1'\d .~} '-AS i~o..\\ ~-c:l...\:>.I)S~r.XY).e..L:I:
y l)'ol"Uls~S a..\\Jov~, VV\~ ,~~ ~ Sdlr>"'e. on. 'T"Y1e ('est
I ~.1.'fIe.L'::!he..r-:e..-W<lS..9....Ca L)~ar~e. r_(~+r~~\;>Qc..Q;-)..'1.EA
'l\\-\-' \\',,,,, .'\):~-\ vr-e..S S\-\c>u \c! 'oG 0 n ,\ \e ()
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I E1E8SEJ:;,IB~LL(1?..:..1(3t !E_.N~r:UE$lQ.Y(}LJ
@The-tlbUSed pers'Jn(s) IS III illllllediale d:lf1fJl1r of (ultl1er abuse alld a Court
; Order IS necessary to pro\t:ct the abused
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@ I believe that service cannot be safely effected by nn adult individual other
than a law enforcement officer.
G I ask for attorney fees flnd costs purslIantto the Protection From Abuse Act
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15 Tho abuse:! wnd or I) hovt'J Sllffercd OlJt.of.pocket losses os 0 resull of
I Defendant's abuse
,
16 The Dt;(endant has 11~(;(j (;1 ',III(;al,i,(.j t:.. 11003 It,,, f..;i-;\'illlg weapons III ills
. abuse f,lgainst the abused person(s)
- . ..--. --. ..~--~-_.-._----_.- ....---.----.--
WHEREFORE, Plaintiff requests that tillS HOlloroble COlJrt award the following
I relief.
I
A Grant a T emporory Order pwsuant to the Protection from Abuse Act.
I (v( Orderrng the Defendant 10 stop abUSing, harassing, threatening and
I stalking the abused (and the Plaintrff) alld stop placing the abused (and the Plaintiff)
in fear of abuse In any place where she/he/they may be found
I
I .... _ . . ( V) EVlcllng the, Qefendallt from tile rosidence located at
I ~.':Bd_~~hG.'D.t.rl'_i--._huc.~i..w__~Jltl__.,
I Street Address City Township County
Pennsylvania .J.12.s-S...
Zip Code
(OR a confidential address at which the abused is now living) and [Iny subsequent
residence In which the abused lives during the pendency of this Order, and granting
exclusive possession of tile fJrernlses to the al.Hlsed. OR If applicable, ordellng tile
Defendant to provide and pay for alternative suitable housing for the abused, approvod
by Plaintiff, and granting exclusive possession of the housing to the abused.}
(~prohiblting the Defendant froll1ilavlllg any contact With the abused,
Including, but not limited to, restraining the Defendant from entering the place of
employment, business C1r scl100l or recreation of tile abused and from harassing tile
abused or tile abused's relatives
II ry~~\" f1 ~:[\~~~}Z~~:~_~~I:~~(IY._~f__~le ~I.~l:ed minor cllrld(rcn) to
(Name(s) of Custodian(s)
( ) Ordellng tht; Defendant to fellnqulsrl the followin~J weapons which he
has used or threatened to LIse ag"inst the abused. . __.. __.__. ._.___._.__.,,_________ ____.__
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----------.-..~--~.._- . ....-. .-.- - ---~..
. . -.--.... _ ...-----.--.-...-..- - .._.---.---_. .---. .-.--- -..-.---,-.- --- . -- _. -. --'-'--~-_..'--------- --_.-.
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:1 \~Jrrectll1[J tile ..\=a..k~il.\o\J-rw~.'1>o.\ic..e.._____..__._._
I (Sl1ellff or otl1er law enforcement agency)
. to serve a cop!, of tllC Pct'tlon and Temporary Order llpon Defendant Wltlloul
,I prepayment of costs
(~D"octlng that the Potltlon and Order In tills matter may be served
upon D\!!f\!!ndont Vilthout tile disclosure of the address of the abused and also directing
the police and all COllrt personnol not to rovenl any reSidential addross of the abused
to the Defendant, hiS cO\Jllsel and any third party.
B. Schedule 0 healing and at such healing, onter a one-year Order which
includes the above in addltron to tho follOWing:
(v?'Gronling temporary support for the abused in the maximum amount
allowed under law
( ) Ordering the Defendant '.0 reimburse Pltllntiffs and the abused's out.
of.pocketlosses sufforad as 0 result of the abuse.
(y(C),dering the Defcndontto pay all costs associated with the filing and
service 01 this law suit and to pay Plaintiffs and the abused's attorney's lees.
( ) Directing the Defendant to __
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(Specify additional relief requested)
~rantlng any other relief the Court deems appropriate.
I verrfy that the statement~ made in this Petition are true and correct to
the best of my knowledge, mformation and belief. I understand that false statements
herein are made subject to tho penalties of 10 Pa. C.S 94904 relating to unsworn
lalslficatlonto autllOrities _ \ /) .' . )
Dated: / /- /". ?.t___._._.. 'ifjZu;.~A J :?~ @t7-~
Plaintiff
REV 12/84
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......L._..___._____..... _...._.
(ID A copy of this Order shall be served on Ihe police department(s) in tho
jurisdictions whero Plolnt,ll re51des Dnd is oll1ployod. This Order shall. likewlso, be
served 011 the State Polrco.! A copy of thlti Order shall be lorthwlth filed In the County
registry 01 ProtecHoll Orders. Copll:~ 5hall also bll provided to the Sheriff, the
Prothonotary, Plalntiffb ceJlll15ol, and Plnlntllf Tho Sherif( or h_ .________.__..._._
(Specify other adultlndivlduol)
is directed to serve alld file the alorl:montloned copies of this Order without prepayment
of costs, Said copies shall be certified.
(j]) This Order shall remain III full force and etfectuntll modified or terminatod
by this Court,
@ The Defendant's Social Security nwnber 15 _
, The date
01 birth 01 the Defendant Is _~___,
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@ A hearing shall be held on the 02/_ day of .}JO\J<.rY1.h-er-
1994> at q: 0 l) AM.I~. in Courtroom No..5 _ of the York County Court
House, located at 28 East Market Street, York, Pennsylvania 17401,
@, THIS IS AN ORDER OF COURT. ANY VIOLATION OF TI-IIS ORDER
SHALL CONSTITUTE CONTEMPT OF COURT AND MAY BE PUNISHABLE BY A
FINE UP TO $1,000,00 AND A JAIL SENTENCE OF UP TO SIX MONTHS.
BY THE COURT,
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'- JUD~
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