HomeMy WebLinkAbout97-02489
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")i("J)( Ulf/!(,\'", Plaintiff
v.
,
<) (.:...tl1 1_,-,il7/(CI''), Defendant
,
MAY 1 ?, 1997 C\~
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
NO. 97- dt.J~ CIVIL TERM
CUSTODY
AND NOW,
~ 0 D
this ~ day of
the attached custody
Order of Court.
Send to:
Plaintiff, ~ ~
lJ,'~-"'Yl ~'
Name
, 1997, the terms of
eement are hereby made an
By the Court,
, J.
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Address
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Address
Defendant
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l)iCbJ ll: {,,\t'flb'j, Plaintiff
IN THE COURT OF COMMON PLEAS OF
v.
CUMBERLAND COUNTY, PENNSYLVANIA
NO. 97- .)LjS<'/ CIVIL TERM
'i~c:JI LJ ,}; Ie (.j', Defendant
CUSTODY
CUSTODY STIPULATION AND AGREEMENT
Made by and between , ~) I ~l I +' 1.1) I ~i/(-' f ')
hereinafter "Mother," currently residing at <jc; ( j 7 " ') 11 (-0(:"1
C(\( I,i/!", pI! /-((JI3 and r)(,";-U L( )'I\~"'/<::'
. ,
hereinafter "Father," currently
l\/i~UJ CL'IJK"/ Ie: .\.A, /IJ /";l.A'":,
I
">"
residing at _,~'C
\"'>, I .-1
l~ir ,c\s'" <.> I
WHEREAS the parents have
a ~hitd~ehilareH, namely:
~
DATE OF BIRTH
('::;'(5'<;;'
NAME
/),\ I) I~, l~ Ll' /~' de \ ')
hereinafter '~"I..i.ldIllR:" and
WHEREAS, the parents wish to enter into an agreement
relative to custody, partial custody and visitation of the
~hi1d!Clli1dF~II;
NOW THEREFORE the parents agree as follows:
1. Mother and Father shall have shared legal custody of the
child/ohild on, meaning that they shall share the legal right to
L---------
make major decisions affecting the best interest of the
..._-"",
(C~i~~10AildrQn and all of the major matters related to the
.~ild/Ch~ldr~ including, but not limited to, medical, religious
and educational decisions.
2. i.!'~".' "we shall have primary physical custody of the
10
/" .--....-..
~ohildren, meaning that this person shall have actual
physical possession and control of the ~~9/child.ren. for a
majority of the time.
J. The other parent shall have(parfi!..L@ysical
--
cUstodY)~ "Partial physical custody" means the person
shall have the right to take possession of the(~hild/eftiAdt.n
away from the other parent for a certain period of time;
"Visitation" means the person shall have the right to visit the
child/children, but does not have the right to remove the
child/children from the custodial person's control" ) as follows:
a. AS AGREED j< L,j 7i,() as agreed to by the parents.
(If you think that you do not need a set schedule, you may stop
here and sign the agreement at the end.)
b. WEEKENDS (Initial choice 1 or 2 or leave blank)
1. ALTERNATING On alternating weekends
beginning on , at . m.
(Day of Week) (Time)
through at . m. and every
(Day of Week) (Time)
other weekend (alternating weekends at the same times.
2 . SPLIT
Every weekend from
(Day
at
.m. through
of Week)
(Time)
(Day of Week)
at
. m.
(Time)
c. DAY IS) DU~ING THE WEEK
From
at
(Initial if agreed)
.m. through
(Day of
Week)
(Time)
(Day of
, at
.m. and each week thereafter at the
Week)
(Time)
11
same times.
d. HOLXDAYS OTHER THAN THANKSGXVXNG AND CHRXSTMAS (Initial
choice 1 or 2 or leave blank)
1. ALTERNATING Holidays shall be
defined as: (Initial holidays that you agree to alternate.)
New Years Day
Easter sunday
Memorial Day
Independence Day (Fourth of July)
Labor Day
During even numbered years, Mother/Father shall have the
child/children on New Years Day, Memorial Day and Labor Day and
the other parent shall have the child/children on Easter Sunday
and Independence Day from .m. through .m.
(Time) (Time)
During odd numbered years, the other parent shall have the
child/children on New Years Day, Memorial Day and Labor Day at
the above times and Mother/Father shall have the child/children
on Easter Sunday and Independence Day at the same times.
2. SPLIT Holidays shall be defined as:
(Xnitial holidays that you agree to split and not alternate.)
New Years Day
Easter Sunday
Memorial Day
Independence Day (Fourth of July)
Labor Day
Holidays shall be split between the parents with the paren~
that does not have primary physical custody having the
12
child/children beginning at .m. on the day of the
(Time)
holiday through m. on the same day.
(Time)
e. MOTHERS DAY AND FATHERS DAY
(Initial if agreed)
Regardless of any weekend schedule agreed to in this agreement,
Mother shall always have the child/children on Mother's Day from
.m. through .m. and Father shall always
(Time) (Time)
have the child/children on Father's Day at the same times.
f. THANKSGIVING Thanksgiving holiday
(Initial if agreed)
shall be defined as beginning on
at
.m.
(Day of week)
(Time)
through
at
.m.
(Day of week) (Time)
(Initial choice 1 or 2 or leave blank)
1. ALTERNATING The parents shall
alternate Thanksgiving holiday with Mother/Father having the
child/children in even numbered years and the other parent having
the child/children in odd numbered years.
2. SPLIT The parents shall split the
Thanksgiving holiday with MOTHER/FATHER having the child/children
from the beginning of the Thanksgiving holiday through
Day of Week
at .m. and the other parent having the child/children
(Time)
from that time through the end of the Thanksgiving holiday.
g. CHRISTMAS Christmas holiday shall be
(Initial if agreed)
defined as beginning on December at .m. and
(Date)
(Time)
13
ending on
at
.m. each year.
(Date) (Time)
(Initial choice 1,2, or 3 or leave blank)
1. split Mother/Father shall have the
child/Children from the beginning of the Christmas holiday
through December at .m. and the other parent
(Date) (Time)
shall have the Child/children from that time to the end of the
Christmas holiday on even/odd numbered years. In the other
years, the other parent shall have the child/children from the
beginning of the Christmas holiday through the above time and
custody shall then be transferred at the above time to
Mother/Father.
2. ALTERNATING Mother/Father shall have
the child/Children during the Christmas holiday in even/odd
years. In the other years, the other parent shall have the
child/children during the Christmas holiday at the same times.
3. FIXED Mother/Father shall each year
have the child/children from the beginning of the Christmas
holiday through December at .m. and the
(Date) (Time)
other parent shall each year have the child/children from that
time to the end of the Christmas holiday.
h. SUMMER VACATION The parent without
(Initial if agreed)
primary physical custody shall have the child/children for
weeks during the summer vacation provided weeks
(Number) (Number)
notice is given to the parent with primary physical custody. The
parent with primary physical custody shall have the
14
child/children for the same number of weeks during the summer
vacation provided the same number of weeks notice is given to the
other parent.
i. KISCELLnNEOUS The parents also agreE
(Initial if agreed)
to the following:
j. Additional periods of visitation and primary physical
custody shall be provided as agreed to by the parties.
4. Transportation of the child/children shall be provided
as follows:
(Fill in the blank)
5. Neither parent shall do anything which may estrange tp~
child from the other parent or injure the opinion of the child as
to the other parent, or which may hamper the free and natural
development of the child's love and affection for the other
parent.
6. Neither parent shall consume alcoholic beverages to the
point of intoxication or consume any unprescribed controlled
substances (drugs) while the child/children is in their care.
7. Each parent agrees to provide the other parent with an
address and telephone number through which the parent may be
contacted during periods of custody of the child/children/ Each
parent further agrees to inform the other parent of any medical
emergencies that arise while the child/children are in that
parent's care.
15
. l..\ ,,-, : IN THE COURT OF COMMON PLEAS OF
\)((tIIICl'\/I dt' \), Plaintiff
: CUMBERLAND COUNTY, PENNSYLVANIA
v.
NO. 97- CIVIL TERM
.
" .
Sc.ut1l~'(/)k I") , Defendant CUSTODY
AFFIDAVIT IN SUPPORT OF PETITION
FOR LEAVE 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 and costs of
prosecuting, defending, or appealing the action or proceeding.
2. I am unable to obtain funds from anyone, including my
family and associates, to pay the costs of litigation.
3. I represent that the information below relating to my
(a)
Name:
fees and costs is true and correct.
"v ,,' I '
1 )i cul( l'-.\(/I ( ~ ')
/{~C 7\1 '''>tl"t-'l:''J
("t., \ I ,', I,' f\' I? L) .3
It,'! ') '/(i 7 (r i (I
-
ability to pay the
Address:
Social Security Number:
(b) If you are presently employed, state
Employer: Kt'lIlJr?il) '/) 'S(1 ( 1,'('('5
Address: / /' I (J)\ ,( '~('.I.'-=-{ (',j ,Iii ~if-
( I !\ \ II r \ I r ,VI (" d., I \
Salary or wages per month: 11<;)"->~0, .{~t}lt:rt
ill (j / . UJ )
Type of work: I ~ I) ) I Jt I (I I <..} ( .( \ I ('(I '-'>')")'11'1'01. :
, J l
If you are presently unemployed, state
Date of last employment:
Salary or wages per month:
Type of work:
28
Motor vehicle: Make f( : r ( I
,,-
Cost ii, 'il; C. (;(
stocks; bonds: ~
Year
/9'0' V
{,
Amount owed
/'
other:
(f) Debts and obligations
Mortgage: /
Rent: ~ Ii {l(u
Loans:
//
Monthly Expenses: Illt,j il ' .;,~( ( ('I, LIe <)~ I (I
.I,.,I'~/. ( " ~')'" ( ",
Cll.J.:j\ Il' (( ,( ("'I il"'/'/ll//(I( ,.')( ( ,1'-"( //I'\,)((,U,
/\,,,1 1'11\( ~/,)'-'(( ,; ",,,.}",'; (( ll,I/!(('lillll(('1,JI/c,(,
~ependent upon '~ou for support I Ill"',!" )Cl'l'('(:~~,"I,,{0
(g)
/
(Wife) (Husband) Name: /
Children, if any:
Name:.LbJ II (l~ kill k, " Age:
I understand that I have a continuing
,
')
/
4.
obligation to
inform the court of improvement in my financial circumstances
which would permit me to pay the costs incurred herein.
5. I verify that the statements made in this affidavit are
true and correct. I understand that false statements herein are
made subject to the penalties of 18 Pa. C.S. 4904, relating to
unsworn falsification to authorities.
Date: ( C; I ') (/ '7
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