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Home My WebLink About03-0575 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA JENNIFER D. NOPHSKER, Plaintiff v. 0<- 575 : NO. .../ JEFFREY J. NOPHSKER, Defendant : CIVIL ACTION - LAW : DIVORCE NOTICE YOU HAVE BEEN SUED IN COURT. If you wish to defend against the claims set forth in the following pages, you must take prompt action. You are warned that if you fail to do so, the case may proceed without you and a decree of divorce or annulment may be entered against you by the court. A judgment may also be entered against you for any other claim or relief requested in these papers by the Plaintiff. You may lose money or property or other rights important to you, including custody or visitation of your children. When the ground for divorce is indignities or irretrievable breakdown of the marriage, you may request marriage counseling. A list of marriage counselors is available in the Office of the Prothonotary at the II County Courthouse, Carlisle, Pennsylvania. IF YOU DO NOT FILE A CLAIM FOR ALIMONY, DIVISION OF PROPERTY, COUNSEL FEES OR EXPENSES BEFORE THE FINAL DECREE OF DIVORCE OR ANNULMENT IS GRANTED, YOU MAY LOSE THE RIGHT TO CLAIM ANY OF THEM. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. CUMBERLAND COUNTY BAR ASSOCIA nON 2 LIBERTY AVENUE CARLISLE, P A 17013 (717) 249-3166 IN THE COURT OF COMMON PLEAS OF CUMBERLANDCOUNTY, PENNSYL VANIA JENNIFER D. NOPHSKER, Plaintiff v. --- ---- : NO. 0:3 - .s 7-i JEFFREY J. NOPHSKER, Defendant : CIVIL ACTION - LAW : DIVORCE COMPLAINT AND NOW, this-7~day of k \o;-U.illj ,20.03.., comes the Plaintiff, JENNIFER D. NOPHSKER by her attorney, Diane G. Radcliff, Esquire, and files this Complaint in Divorce of which the following is a statement: COUNT I DIVORCE 1. The Plaintiff is Jennifer D. Nophsker, an adult individual who currently resides 2904 Chesterbrook Court, #404, Camp Hill, Cumberland County, PA 17011 since April 12, 2002 . 2. The Defendant is Jeffrey 1. Nophsker, an adult individual residing at 1249 Rossmoyne Road, Mechanicsburg, Cumberland County, PA 17055 since the Spring of 1997. 3. Plaintiff and Defendant have been bona fide residents in the Commonwealth for at least six (6) months previous to the filing of this Complaint. 4. Plaintiff and Defendant were married on May 27, 2000 at Mechanicsburg, Cumberland County, Pennsylvania. -1- 5. There have been no prior actions of divorce or annulment between the parties. 6. Plaintiffhas been advised that counseling is available and that Plaintiff may have the right to request that the Court require the parties to participate in counseling. 7. Plaintiff avers that the grounds on which the action is based are: a. Section 3301(c) Mutual Consent No-Fault: The marriage is irretrievably broken; b. Section 330Hd) Non-Consent No-Fault: The marriage is irretrievably broken and the parties are now living separate and apart. Once the parties have lived separate and apart for a period of two years, PlaintiffwiII submit an Affidavit alleging that the parties have lived separate and apart for at least two (2) years and that the marriage is irretrievably broken. 8. Plaintiff requests the Court to enter a decree of divorce. 9. Defendant is not a member of the Armed Services of the United States or any of its Allies. WHEREFORE, Plaintiff requests this Honorable Court to enter a decree in divorce, divorcing the Plaintiff and Defendant. Respectfully submitted, ~~~( 3 ad Camp Hill, PA 1701 I Phone: (717) 737-0100 Fax: (717) 975-0697 Supreme Court ID # 321 12 Attorney for Plaintiff -2- VERIFICATION Jennifer D. Nophsker verifies that the statements made in this Complaint are true and correct. Jennifer D. Nophsker understands that false statements herein are made subject to the penalties of18 Pa.C.S. Section 4904, relating to unsworn falsification to authorities. Date: -3- ~ C r " . 0 "" I I ~ ~ =1t 1"-' .-..; ~ v "'- a '^-> '-.Ao ~ .. ~ ~ -"j ~ 10 -, (.) ~ \S, OQ ~ ~ ~ (\ -- ~ IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA JENNIFER D. NOPHSKER, Plaintiff v. : NO. 03-575 CIVIL TERM JEFFREY J. NOPHSKER, Defendant : CIVIL ACTION - LAW : DIVORCE CERTIFICATE OF SER'VICE I hereby certify that I, Diane G. Radcliff, Esquire, served a true and correct copy of the Complaint in Divorce upon the following named Defendant addressed as follows by Certified Mail, Restricted Delivery on the 15th day of FebIUary 2003, the return receipt for which mailing is attached hereto as Exhibit "A" and made a part hereof: Jeffrey J. Nophsker 1249 Rossmoyne Road Mechanicsburg, PA 17055 Respectfully submitted, ~~l 448 Trin Road Camp Hill, PA 17011 Phone: (717) 737-0100 Fax: (717) 975-0697 Supreme Court lD # 32112 Attorney for Plaintiff . Complete items 1, 2, and 3. Also complete item 4 if Restricted Delivery is desired. . Print your name and address on the reverse so that we can return the card to you. . Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed to: !~O/ J NO(Jh 5& yo I '-19 ROS5rno~ne Rd. 'chln(~IauYj P A- '''lOSS- 3. ~ice Type ~rtified Mail 0 Express Mail o Registered 0 Return Receipt for Merchandise o Insured Mail 0 C.O.D. 4. Restricted Delivery? (Extra Fee) Xves 2. Article Number (Copy from service label) 7/0 ,/ 7oq9 ..3 r/ () ~ 000.3 7' PS Form 3811, July 1999 Domestic Return Receipt ~~'~/ 102595-99-M-1789 EXHIBIT "A" CERTIFIED MAIL RETURN RECEIPT CARD ) 4 "7) t'-f) rq t~' 2~ ,0:" -,7 r- (/~ .~ r-:::: ;r~l> (__ 1):~ J~ n c :?' ""t)c!~ qJr-; Z(~ ~J J r= j::':r -7.. _ ~..:::= r'-',\ );~'v So ~ --. () C <:~ .....; C.'" W n \'1 '-I ,.....,) C1J IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA JENNIFER D. NOPHSTER, Plaintiff NO. 03-575 V. CIVIL ACTION - LAW IN DIVORCE JEFFREY J. NOPHSKER, Defendant AFFIDAVIT OF CONSENT 1. A Complaint in Divorce under Section 3301(c) of the Divorce Code was filed on February 6, 2003. 2. The marriage of Plaintiff and Defendant is irretrievably broken and ninety (90) days have elapsed from the date of filing and service of the Complaint. 3. I consent to the entry of a final Decree in Divorce after service of notice of intention to request entry of the decree. 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. Section 4904 relating to unsworn falsification to authorities. Dated: 3/g/b3 .----.~.. ~ 0 0 W -n :J!: ...... -00:' :D>' ~~fR '3?! rr .....: :e. N ....~t3 ZC. cp'~., O? . ~.,~ I ~..:. .-..C> ~C) :.-c- .~~ ?zg :Jt - 5>~ - :.:.::/11 ......\ ~ 55 (? ~ IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA JENNIFER D. NOPHSTER, Plaintiff V. NO. 03-575 CIVIL ACTION - LAW IN DIVORCE JEFFREY J. NOPHSKER, Defendant WAIVER OF NOTICE OF INTENTION TO REQUEST ENTRY OF A DIVORCE DECREE UNDER SECTION 3301(c) OF THE DIVORCE CODE 1. I consent to the entry of a final decree in divorce without notice. 2. I understand that I may lose rights concerning alimony, division of property, lawyer's fees or expenses if I do not claim them before a divorce is granted. 3. I understand that I will not be divorced until a divorce decree is entered by the Court and that a copy of the decree will be sent to me immediately after it is filed with the Prothonotary. I verify that the statements made in this Waiver are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. 54904 relating to unsworn falsification Dated: 5/~I} U3 to authorities. (") c: ~ -CO) rnr~' z:E zc.. cn,,E ~t:; ')>0 ZCl ~c: ~ ... C"J W o -n :.:.:.! ':-\E ~j.;~? :..::~p .~-- T.I ...") -n .~n Of'n -"'\ ?Q ~ ~ 'P .-<: N co ~ ~ C> IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA JENNIFER D. NOPHSKER, Plaintiff NO. 03-575 V. CIVIL ACTION - LAW IN DIVORCE JEFFREY J. NOPHSKER, Defendant IF YOU WISH TO DENY ANY OF THE STATEMENTS SET FORTH IN THIS AFFIDAVIT, YOU MUST FILE A COUNTER-AFFIDAVIT WITHIN TWENTY DAYS AFTER THIS AFFIDAVIT HAS BEEN SERVED ON YOU OR THE STATEMENTS WILL BE ADMITTED. AFFIDAVIT UNDER SECTION 330Hd) OF THE DIVORCE CODE I. The parties to this action separated on April 12, 2002 and have continued to live separate and apart for a period of at least two years. 2. The marriage is irretrievably broken. 3. I understand that I may lose rights concerning alimony, division of property, lawyer's fees or expenses in do not claim them before a divorce is granted. 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. Section 4904 relating to unsworn falsifications to au rities. 1 Date: 1!ff1/ULf o c: ~ltt Q)rr,: 61 ~,~~.,) -.0..... C:::C' ~~ z :3 , "> <= <=> .<;- :x :> -< I 0'\ """ ~ 9 n :r! rl1~ 'Um :00 o,t --<,.) :r-r --rof C::>---' ZC"} C)m -j )> :n -< 'f? en \0 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA tf:;t ORIGINAL JENNIFER D. NOPHSKER, Plaintiff v. : NO. 03-575 CIVIL TERM JEFFREY J. NOPHSKER, Defendant : CIVIL ACTION - LAW : DIVORCE AFFIDAVIT OF SERVICE I, the undersigned, being duly sworn/affirmed according to law, deposes and says: I. I am over 18 years of age and am not related to either party to this action. 2. I served a true and correct copy of the 3301(d) Affidavit, upon the Defendant, Jeffrey J. Nophsker, on &> ' ). - (!:> r by the manner checked below: [, a. [ ] [ ] Handing a copy to Defendant at lJ1/cf,~nlcJd"A-s /,1 1'1 Pi gos.r!H o 'IN ,. 'l-o"p.,f) . b. Handing a copy to ._, an adult member of the family with whom the Defendant resides at Defendant's residence located at , or if that person is not a member of Defendant's family, then said person is the adult person in charge of Defendant's said residence; c. Handing a copy to , at said person being the Defendant's agent or to the person for the time being in charge of Defondant'<offjce 0'_,] pl~, Ofbu~J~ . . (Sigru<ru# (~vt.. ,4;t.O Jd~,:/z~ (Printed name) NOTARIAL SEAL SUZANNE M. DEOERER, Notary Public Camp Hill Boro, Cumberland County My Commission Expires Aug. 20, 2005 ",j\", ...' Ch "/..,~.:1( 2- '" 0 = ,= "T1 S; or- '- ::2 t:= nl~ ~ ;g~ m S~ . -'-'1 -CJ ~4b ~- -+-~ Om ~ _..,J j> =2 c....' ::0 +.'. .< l;, OmmNAl IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA JENNIFER D. NOPHSKER, Plaintiff v. : NO. 03-575 CNIL TERM JEFFREY J. NOPHSKER, Defendant : CNIL ACTION - LAW : DNORCE CERTIFICATE OF SERVICE I hereby certify that I, Diane G. Radcliff, Esquire, served a true and correct copy of the Notice ofIntentto Entry on 30 1 (d) Divorce Decree and 3301 (d) Counter-Affidavit upon the following named Defendant addressed as follows by Certified Mail, Restricted Delivery on the 30th day of June, 2004, the return receipt for whkh mailing is attached hereto as Exhibit "A" and made a part hereof: Jeffrey J. Nophsker 1249 Rossmoyne Road Mechanicsburg, P A 17055 Respectfully submitted, ~ II ;------:, DCLlFF, ESQUl 448 Trindle lad Cam 17011 Phone: (717) 737-0100 Fax: (717) 975-0697 Supreme Court ID # 32112 Attorney for Plaintiff . Complete items 1, 2, and 3. Also complete item 4 if Restricted Delivery is desired. . Print your name and address on the reverse 50 that we can return the card to you. . Attach this card to the back of the mailpiece. or on the front if space permits. 1. Article Addressed to: T~~"I tJ6~~ \~49 ~CS~lY'l)il\lL ~Pd ('(\e...~nl\('\.<~\N~j ~ IlD5S :"pe / . . ~~zt.a Express Mail o Registered 0 Return Receipt for Merchandise o Insure,j Mail 0 C.O.D. 4. Restricted Delivery? (Extra Fee) ~ Yes 2. Article Number (Copy from service label) 1ll"\<=t ~400 COn -:>, '1loit 4:;?/ ~ Domestic Return Receipt 102595-99-M-1789 PS Form 3811, July 1999 EXHIBIT "A" CERTIFIED MAIL RETURN RECEIPT CARD -. C'~ "'" cZ) 0 C':;, ~; .r- "1, c_ -I C.: :T' zi f-' rTi:!J ~= fn "0 D ;<l ~:j p( :.1) ~( ~~ ~ ,~'-.... ~ ';,~.) I""r'i (J~ JENNIFER D. NOPHSKER, Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYL VANIA v. JEFFREY 1. NOPHSKER, Defendant : NO. 03-575 CIVIL TERM : CIVIL ACTION - LA W : DIVORCE '1'0 'l'HE PROTHONOTARY: PRAECIPB OF TRANSMIT RBCORD Transmit the record, together with the following information, to the COurt for entry of a divorce decree: 1. GROllND FOR DlVORCB: Irretrievable breakdown under Section 3301(d) of the Divorce Code. 2. DATB a. b. c. OF FILING AND HAmmR OF SBRVICE OF 'l'HE COMPLAINT: Date of filinq of Comolaint: February 6, 2003 Manner of service of Comolaint: Certified Mail, Restricted Delivery Date of Service of Comolaint: February IS, 2003 3. DATB OF BXBCUTION OF THB AFFIDAVIT OF CONSBNT REQUIRED BY SBCTION 3301 (C) OF THE DlVORCB CODE: a. Plaintiff: N/A b. Defendant: N/A .QR DATE OF BXECUTION OF THB PLAINTIFF'S AFFIDAVIT RBQUIRED BY SBCTION 3301(0) OF 'l'HE DIVORCB CODB AND DATB OF SBRVICE OF THB PLAINTIFF'S 3301 (D) AFFIDAVIT UPON THE DBFBNDANT: a. Date of Execution: b. Date of Filing: c. Date of Service: April 29, 2004 May 6, 2004 June 2, 2004 4. RBLATBD CLAIMS PBNDING: No issues have been raised in this case, and there are no issues outstanding. 5 . DATB AND HAmmR OF SBRVICB OF 'l'HE NOTICB OF INTENTION TO FILB PRAECIPE TO TRANSMIT RBCORD, A COpy OF WHICH IS ATTACHBD, IF 'l'HE DBCREE IS TO BB BNTBRBD llNDBR SBCTION 3301(0) (1) (I) OF THE DlVORCB CODB: a. Date of Service: June 30, 2004 b. Manner of Service: Certified Mail, Restricted Delivery OR DATE WAIVER OF NOTICB IN SBCTION 3301 (C) DIVORCB WAS FILBD WITH THB PROTHONOTARY, a. Plaintiff's Waiver: N/A b. Defendant's Waiver: N/A CLIFF, ESQUIRE Tri Ie Road Camp 111, PA 17011 Supreme COurt ID # 32112 Phone: (717) 737-0100 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYL VANIA JENNIFER D. NOPHSKER, Plaintiff v. . NO. 03-575 CIVIL TERM JEFFREY 1. NOPHSKER, Defendant : CIVIL ACTION - LA W : DIVORCE NOTICE OF INTENTION TO RE VEST ENTRY OF 3301 d DIVORCE DECREE TO: JEFFREY1.NOPHSKER,DEFENDANT You have been sued in an action for diVorce. You have failed to answer the complaint or file a Counter-affidavit to the 330 I (d) affidavir. Therefore, on or after July 14, 2004, the other party can request the COurt to enter a final decree in divorce. If you do not file with the Prothonotary of the court an answer with your signature notarized or verified or a COunter-affidavit by the above date, the court can enter a final decree in divorce. A COunter- affidavit which you may file with the Prothonotary of the court is attached to this notice. Unless you have already filed with the court a written claim for economic relief, you must do so by the above date or the court may grant the divorce and you will lose forever the right to ask for economic relief. A COUNTER-AFFIDA VIT WHICH YOU MAY FILE WITH THE PROTHONOTARY OF THE COURT IS A TT ACHED TO THIS NOTICE. The filing of the form counter-affidavit alone does not protect your economic claims. You SHOULD TAKE THIS PAPER TO YOVRLAWYER AT ONCE. IF YOU DO NOT HA VE A LA WYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. CUMBERLAND COUNTY BAR ASSOCIATION 2 LIBERTY A VENUE CARLISLE, P A 17013 , (717)249_~ D DCLIFF, ESQUIRE 34 Road Camp Hill, P A 170 II Supreme Court ID # 32112 Attorney for Plaintiff JENNIFER D. NOPHSKER, Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYL VANIA v. : NO. 03-575 CIVIL TERM JEFFREY 1. NOPHSKER, Defendant : CIVIL ACTION - LA W : DIVORCE COUNTER-AFFIDA VIT UNDER SECTION 330Hd} 0.1' THE DIVORCE CODE ,. Check either (a) or (b): [J (a) I do not oppose the entry ofa divorce decree. [ J (b) I oppose the entry ofa divorce decree because Check (i), (ii) or both: [J [J (i) The parties to this action have not lived separate and apart for a period of at least two years. (ii) The marriage is not irretrievably broken. 2. Check either (a) or (b): [ J (a) I do not wish to make any claims for economic relief I understand that I may lose rights concerning alimony, division of property, lawyer's fees or expenses in do not claim them before a divorce is granted. [J (b) I wish to claim economic relief which may include alimony, division of property , lawyer's fees or expenses or other important rights. I understand that in addition to checking (b) above, I must also file all of my economic claims with the Prothonotary in writing and serve them on the other party. IfI fail to do so before the date set forth on the Notice oflntention to Request Divorce Decree, the divorce decree may be entered without further delay. I verify that the statements made in this Counter-affidavit are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. Section 4904 relating to unsworn falsification to authorities. Date: JEFFREY J. NOPHSKER, DEFENDANT NOTICE: IF YOU DO NOT WISH TO OPPOSE THE ENTRY OF A DIVORCE DECREE AND YOU DO NOT WISH ANY CLAIM FOR ECONOMIC RELIEF, YOU SHOULD NOT FILE THIS COUNTER-AFFIDA VIT. JENNIFER D. NOPHSKER. Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYL VANIA v. JEFFREY J. NOPHSKER, Defendant : NO. 03-575 CIVIL TERM : CIVIL ACTION - LA W : DIVORCE ~J t.;: c; ~_'~ -II t.....- -l c:" In- :,\-. -f.'::7:! -;1"'.0" :.:~ <-:-.1 CERTIFICATE OF SERVICE ", '."'. '"] . ~ ~ ;-: -;.;: c.,n ...... I hereby certity that I, Diane G. Radcliff, Esquire, served a true and correct copy of _,:.r J.::';', (';~., . .0"' ",. the Notice ofIntentto Entryof3301 (d) Divorce Decree and 3301 (d) Counter-Affidavit upon the following named Defendant addressed as follows by Certified Mail, Restricted Delivery on the 30'h day of June, 2004, the retum receipt for which mailing is attached hereto as Exhibit "A" and made a part hereof; Jeffrey J. Nophsker 1249 Rossmoyne Road Mechanicsburg, PA 17055 Respectfully submitted, I I DCLIFF, ESQUI I ad Carn 17011 Phone: (717) 737-0/00 Fax; (717) 975-0697 Supreme Court ID # 32112 Attomey for Plaintiff Te.q'~ J. k)o~~ 1~49 ~as~jh~~ ~Pd rn~c:.nA.I'IC:~~~j ~ flDSS · Complete items 1, 2. snd 3. Also complete item 4 if Restricted Delivery is desired. · Print your name and address on the reverse so that We can return the card to you. · Attach this card to the back of the mailpiece, Or on the front if space permits. 1. Article Addressed 1'0; I I! I 2. Arliele Number (Copy from sefVtCe label) pe ." if ~r' ".U EJeP1'e8s Mail o Registered 0 Return Receipl for Merchandise ' o InSllred Mall 0 C.O.D. 4. AeSllicted DeliV8ly? (Extra Fee) ~ Yes PS Form 3811, July 1999 102595.99.M"7B9 EXHIBIT "A" CERTIFIED MAIL RETURN RECEIPT CARD , r-:: ~ .- .ni -<. ~ <-, ,.> .s:- <.- c: r 1'.) () -il ~" ri'r= -L"in ~~~~ ','J" ~..: i i1 ;:: c., ~ -~~ .J -'. IN THE COURT OF COMMON PLEAS OFCUMBERLANDCOUNTY STATE OF JENNIFER D. NOPHSKER, Plaintiff VERSUS JEFFREY J. NOPHSKER, Defendant AND NOW, PEN NA. No. 03-575 CIVIL TERM DECREE IN DIVORCE 1'-1 .:t?S ,2004 IT IS ORDERED AND DECREED THAT JENNIFER D. NOPHSKER , PLAINTIFF, AND JEFFREY J. NOPHSKER , DEFENDANT, ARE DIVORCED FROM THE BONDS OF MATRIMONY. THE COURT RETAINS JURISDICTION OF THE FOLLOWING CLAIMS WHICH HAVE BEEN RAISED OF RECORD IN THIS ACTION FOR WHICH A FINAL ORDER HAS NOT YET BEEN ENTERED; . No issues have been raised in this case, and no issues are outstanding. . J. ROTHONOTARY . L~ ~ .~ 7??2.P// ~ ~r ~ ,..., . ;c''''''' nt7'~"L ~~V p~ ~11":V~ -.p'l p(/-OF-L, , . " IN THE COURT OF COMMON PLEAS OF CUMlBERLAND COUNTY, PENNSYL VANIA 11lmfer D NO/JhsW . Plaintiff Vs .]iffrfj J~ N()phSUr Defendant File No. 05- 575 (11///1&11t IN DIVORCE NOTICE TO RESUME PRIOR SURNAME Notice is hereby given that the Plaintiff / defendant in the~ above matter, [select one by marking "x"] _ prior to the entry of a Final Decree in Divorce, . or L after the entry of a Final Decree in Divor<~e dated 1u1~ 7-7, 7JXJ r/, hereby elects to resume the prior surname of ....Ad a 0 Gr.e (I (1V" , and gives this written notice avowing his / her intention pursuant to the pr~l'is~,1J 54 r;s. 704. Date:~ ';! /~m Signature COMMONWE.~fTHOFP. ENNSYLVANIA ) COUNTY OF ~tlAA~ On the ---kl- day of , 200S::: before me, the Prothonotary or the notary public, personally appear the above affiant known to me to be the person whose name is subscribed to the within document and acknowledged that he / she executed the foregoing for the purpose therein contained. In Witness Whereof, I have hereunto set my hand hereunto set my hand and official seal. ~ NOTARIAl SEAL PIl0lHONOTARY. NOTARY PUBU& C.All.ISlE CUMB8llAND COUNlY COURT HOUSE MY COMMISSION EXPIRES JANUARY 2. 2Oll6 (} r--~_" ~ 4- = 0 .~=) ~ c..t'"l -n *- :~ Cl C) " -----0 1 --- ~ <;;:' -;:; l;" \:J -".- ,...\) ~ - <'. .. ~ '-^ -<. Go) ~ ~ -! ~ Pr C(> ..., ~ C ...,