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HomeMy WebLinkAbout97-02864 ~ '" .::J Q - CJ ~ ~ q ~ ~ ~ ~ j '::l-. ~ / ~/ , l:-- ~ ~ / -' /' , / , I \ child meaning that this person shall have actual physical possession and control of the child for a majority of the time. 3. The other parent shall have partial physical custody. "Partial physical custody" means the person shall have the right to take possession of the child away from the other parent for a certain period of time. Stephen Clouser may not take the child anywhere without Angela's knowledge of his whereabouts and her consent. 4. The parties agree that Angela Hoffman has the right to reside with the child whereever she pleases, including in another state. . . 5, Neither parent shall do anything which may estrange the 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 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. Each parent further agrees to inform the other parent of any medical emergencies that arise while the child is in that parent's care. 8. The failure of either parent to insist on strict " (\\ !lVVd \ leU f (:n/J , Plaintiff IN THE COURT OF COMMON PLEAS OF v. CUMBERLAND COUNTY, PENNSYLVANIA NO. 97- J.'iffDt{ CIVIL TERM CUSTODY JII:'\.A)(\ tf (lcu:"l'(, Defendant PETITION FOR LEAVE TO PROCEED AS AN INDIGENT 1. plaintiff in the above-titled action, on this dll day of "Ylo. 'I , 1997, respectfully requests this Honorable Court to grant her leave to proceed as an indigent to the extent that she be relieved from paying the fees and costs in this procedure. 2. plaintiff has been screened for income eligibility at Legal Services, Inc., has been determined eligible, and has attended a custody class at Legal Services taught by a private attorney who was providing services free of charge as part of the Cumberland county Bar Association's pro bono plan. Verification is attached. 3. plaintiff has attached an affidavit in support of this petition. By the plaintiff I verify that the plaintiff has been determined by Legal services, Inc. to meet their financial eligibility guidelines and that the plaintiff has attended a custody class. ~L4Y. 1}- ~-\f,e- 27 (\IIC\'lid \ 1tI\ I' . IN THE COURT OF COMMON PLEAS OF \(;/1 Plaintiff CUMBERLAND COUNTlC, PENNSlCLVANIA V. 97- v< ~foLf NO. CIVIL TERM ~:::I \ 'i~4i\ \ 1 ( (lei ".1" Defendant CUSTODlC 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 ability to pay the fees and costs is true and correct. (a) Name: Ad ' (d (,) ~Ic, r-+; )\( ill , Address: 1','- X" \ .'" \\ ,(\\\,r (-,\r',~'(' Ild 1N-+ll,)l/ lnl' ( \\C\\ \lC" \ I 1,'(0 'VH I tiI i-, Security Number: lii, ,- /~', - ,) l t ('\~ social (b) If you are presently employed, state Employer: Address: Salary or wages per month: Type of work: If you are presently unemployed, state Date of last employment: ~,r~'(/-i Salary or wages per month: '":;-/.j :y-,; Type of work: .-L)l I I('CI \ 28 .... Lfl . ~ [I; ~ "- Ie ..... lljl " " (.) ~ "' fF -:: ::: ~l[' ::.J G\ ; .~~~ ~ b " ..,., ('oJ L:J - ~? ~ [!l :-- ';0 1... .;,' lJ- ~ r--: :,.": " u~ r- . 0 O' .J . . IN THE COURT or COMMON PLEAS of CUMBERLAND COUNTY, PENNSYLVAJIIA.,. . . NO. 97- ,;1, &'G11f CIVIL TERM A--qelu L li~ffil1(ij1' v. Plaintif~ CUSTODY c-..... I [C.I~ ~(I" Defendant '-'Il:.r.Il&.\1 ' ...L':'~ ~STODY STIPULATION AND Mac1e by I'nd between , , I AGREEMENT ... herainafter "Hother," currently reFoiding at \~,-::''.I' ',I::r:,i'~. (.,.r-n? Or-I 1M ,;~, '\\(l(\'('\lir~\;.llrl1 iY\ 'll'f":", and ~~P;\\\()\ ~ F Crt \C:PI' ..JP' I .......'.:::aCJu",!'-Fatiler." e~',rrently rIlll.i.dina at 1l,~": '] !~'~L- '1:':"(,9, r:,;.",nr,\ !Vr P.lr.rl''''. l-"c, t.!1I('f'lIfi(.l\(1 '\Ill \\c)\.i''''~ WHEREAS the parents have a child/.d..111_II~1 nlUllely: ~ W'I(':\. ~:cv.. ,ON \!:(' ,- DATE OF BIRTH 1"~D.Cll hereinafter "child!..l..!,],1. -ti," and WHEREAS, the parants wish to enter into an agreement ralativa to cuatody, partial custody and visitation at the child! aiti:LlInll: NOW THEREFORE the parents agree as follows: 1. Hothar and rather shall have shared legal custody of the ahild/~l~T-A, meaning that they 3hall ahare the legal right to make major decisions affect~ng the best intsrest of the chUc1! O!l '] '1:1- and all of the major mattBrS related to the child/~kil...A, including, but not limited to, medical, religioue and educational dacisions. ~. Koth.riFT~~-- shall have primary physical cuoecdy of tha . , 01 , 'II " ' ,'II .' , ,', ,- " ','" , ,in , ~ '. iii,; . ., ~.. ".' child meaning that this person shall have actual physical possession and control of the child for a majority of the time. 3. The other parent shall havs pa~tial physical custody. .Partial physical custody. means the person shall havs the right to take possession of the child away from the other parent for a certain period of time. Stephen Clouser may not take the child anywhere without Angela's knowledg~ of his wh~reabouts and her Ilonaent. 4. The parties agree that Angela Hoffman has the right to reside with the child whereever she pleases, inclUding in another .tate. 5. Neither parent ahall do ~nythi~~ which may estrange the chi1d from the other parent or injure th~ ~pi~i~n of ~he child as to the other parent, or which may hamper the free and natural development of the child's love anel affection for the other parent. 5. Neither parent shall consume alcoholic beverages to the point of intoxication or consume any unprsscribed contro1led eubstances (druge) while the child is in their care. 7. Each parent agrees to provide the other parent with an '~ . address and telephone number throU!lh which the parent may be contactsd during periods of custody of the child. Each parent further agrees to inform the other parent of any medical emergencies that arise while the child is in that parent's care. a. The failure of .,ther parent to ,nsist on strict " ' 13, The said WENDY STRAWSER isrcprcscnlcd by counscl. to wit: R, Scott Cmmcr. p, 0, Box 159, Duncannon, P A 17020, 14, Said child's Iifc stylc to datc has been what can charitably betcrmed "peripatetic." 15, On Junc 2,1997, Thc Honorablc J. Wcslcy Olcr, Jr,. J" signed an ORDERdockctcd to Cumberland County Court of Common Picas, No, 97-2864 Civil Tcrm. Custody, which, i11ffl: al1.a. providcd that thc said ANGELA L, HOFFMAN, n,k,a, ANGELA L, GREENWALD and the said Stephcn wcrc to havc shared Icgal cuslody ofthc said child and wcrc to share thc Icgal right to makc major decisions affccting thc bcst intcrest of the child and all major matters related to thc child, including but not limited to medical. religious and educational dccisions, (Scc copy of ordcr and thc Custody Stipulation and Agreement attachcd thcrcto allached hercto as "Exhibit A, ") 16. All thc parties hcrcto arc in full and complctc agrecment that the aforementioncd peripatctic lifcstylc ofthc said child is not in thc best intcrcst ofthc said child and that a good, wholcsomc, and more beneficial alternativc is rcadily availablc in thc form of an agrccd custody to rcsidc with thc said matcrnal grandparcnts, AGREEMENT 17. WHEREFORE, IT IS AGREED AS FOLLOWS; ANYTHING IN THE SAID ORDER AND CUSTODY STIPULATION AGREEMENT TO THE CONTRARY NOTWITHSTANDING: 18, Thc said two natural parcnts shall, for thc timc bcing and until further noticc, give up and release their rights to legal custody of said child to the said child's maternal grandparcnts who havc bcen and arc currcntly providing a good and stable homc for thc said child, The said child is currcntly attcnding thc clcmcntary schools in the Cumbcrland Vallcy School District, is doing wcll in school, and is happy and wcll-adjusted to hcr currcnt surroundings, teachers, and friends, 19, By making this AGREEMEl'iT neithcr of the said natural parents is forcvcr relinquishing his or hcr rights as a parcnt and rcserves thc right to petition the Court or to takc other action as may be dccmcd to bc inthc best intercst of the said child if circumstances warrant and justify such action, 20, Thc said matcrnal grandparcnts arc to havc hcnceforth and until further notice thc Icgal custody of said child. Additionally. thcy arc to havc thc legal rights to makc major dccisions affccting thc best interest of thc said child and all major mattcrs rclatcd to the child, including but not limitcd to. mcdical. rcligious and educational dccisions. 21, Thc said rights as they relatc to medical dccisions shall bc substantially those as now authorizcd by the PEF Codc as it relatcs to Powcrs of Attorncy as is morc fully set forth, as follows, except that in thc cvent thc said child is in an arguably terminal medical condition, no decision to rcfuse or \\ithdraw lifc support shall bc made without communication with both natural parcnts, HEALTH CARE POWERS -In addition, thc matcrnal grandparents hcrcby and shall bc authorizcd to makc health carc and mcdical trcatmcnt decisions for the child which shall include, but not be limitcd to thc following: .' A, To havc full and unfcllcrcd acccss to and to rcvicw hcr mcdical and similar rccords with any Doctor or othcr hcalth carc providcr or similar carc providcr, This powcr shall bc full and absolutc and shall includc thc powcr to grant rclcascs for thc disscmination of suchinformation to othcrs, This powcr shall bc cxcrcisablc dcspitc anything to thc contrary in any currcnt privacy acts or similar acts or rcgulations or such as may bc passed or adoptcd fromtimc to timc in thc futurc, 8, To authorizc thc child's admission to a mcdical, nursing, rcsidcntial or similar facility and to cntcr into agrccmcnts for hcr carc; C, To authorizc mcdical and surgical proccdurcs; D, To authorizc thc administration of pain rclicving drugs or othcr mcdical or surgical proccdurcs calculated to rclicvc my pain cvcn though thcir usc may Icad to pcrmancnt physical damagc, addiction or cvcn hastcn thc momcnt of (but not intcntionally causc) thc child's dcath and to authorizc unconvcntional pain rclicf thcrapics which thcy bclicvc may bc hclpfulto thc said child; E, To withhold conscntto any mcdical carc or trcatmcnt (including mcdical and surgical procedurcs); F, To rcvokc or changc any conscnt prcviously givcn or implicd by law for any mcdical carc or trcatmcnt (including mcdical and surgical proccdurcs); Q, To arrangc for thc child's rcmoval from any mcdical or nursing facility; and H, To grant, in conjunction with any instructions givcn undcr such powcrs, relcascs to hospital staff, physicians, nurscs and othcr mcdical and hospital administration pcrsonncl who act in rcliancc on instructions givcn by said matcrnal grandparcnts or who rcndcr writtcn opinions to said matcrnal grandparcnts in conncction with any mattcr dcscribcd in this powcr from all liability for damagcs suffcred or to bc suffcred by said child; to sign documcnts titlcd or purporting to bc a "Rcfusalto Pcrmit Trcatmcnt" and "Lcaving Hospital Against Mcdical Advicc:' as wcll as any ncccssary waivcrs of or rcleascs from liability requircd by any hospital or physician to implcmcnt my wishcs rcgarding mcdicaltrcatmcnt or non-trcatmcnt. 22, Givcn thc gcncral human inability to forcscc all future cvcnts as thcy may dcvclop. in thc cvcnt any third party challcngcs thc authority of thc matcrnal grandparents to makc decisions on bchalf of and for thc bcncfit of said child, thc said matcrnal grandparents may. ifin good faith thcy decm itthc wisest and most prudcnt coursc to act immcdiatcly in the intcrcst of the said child, to takc immediatc action, including pctitions to the Orphans' Court withoutthc joindcr of allthc parties hercto, 23. Currcntly, thc matcrnal grandparcnts arc maintaining posscssion of said child throughout the wcck, Thc paternal grandparcnt obtains posscssion of said child on Friday cvcnings and returns said child to thc said matcrnal grandparcnts on Sunday cvcnings, Thc said grandparcnts arc currcntly splilling holidays, thc patcrnal grandparcnt obtaining posscssion of said child in mid-aftcrnoon and rcturning said child in thc cvcning, Thc samc rcgimc shall bc continued until modificd by thc mutual '- co E~ j' N " i'-:! a-.. " ( , ;5,,( ~J," , " )" . ~ ,~,' ~ ( -;. ..:: p..... '.:'J ,y:,; N . .. . t_, f') elL: - UJ u.. ~ ~\~ i: " \~l .... l- ll.. -'" :':J = 0 c.;..J u ...... .. . .