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MERRICK & FAIR,
Plaintiff
IN TilE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
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CIVIL ACTION - LA W
NO. 9831','ilCIVIL TERM
SAMIR HALABI,
Dcfcndmll
ATTORNEY'S AFFIDAVIT SUPPORTING PETITION
FOR LEAVE TO PROO~lm IN FORMA PAUPERIS
1, George B. Faller, Jr., Esquire, ofthc firm of MARTSON, DEARDORFF, WILLIAMS &
OTTO, attorney for the party petitioning to procced in forma pauperis, certify that [ believe
petitioners are unablc to pay the costs of instituting this action and that 1 am providing free legal
service to petitioners.
Delendant's Aftidavi\ showing inability to pay the costs of litigation is attached hereto.
MARTSO~Drr RDORFF.WILLlAMS & OTTO
/ lS~<<1l,
By ._", ' . ,.' 2tfl1
George 13. Faller, Jr., Esquire
J.D. Number 49813
Ten East High Street
Carlisle, P A 17013-3093
(717) 243-3341
Attorneys for Defendant
Date: June 26, 1998
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MERRICK & FAIR,
Plaintiff
IN TilE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
v.
CIVIL ACTION - LAW
NO. 98-3l'9oCIVIL TERM
SAMIR HALABI,
Defendant
AFFIDA VIT SUPPORTING PETITION FOR LEAVE
TO PROCEED IN FORMA PAUPERIS
TO THE HONORABLE JUDGES OF SAID COURT:
The Pctitioner, Samir Halabi, residing at 30 North Orange Strect, Carlisle, Cumberland
County, Pennsylvania, upon his oath deposes and says:
I. I am the named Defendant in the abovc titled civil cause of action and the Plaintiff
is Men'ick & Fair.
2. This affidavit is made to inform the court as to my status of indigency and to induce
the court to grant me leave to proceed in this cause as an indigent.
3. In making this affidavit, I am aware that perjury is a felony and that the punishment
is a fine of not more than $3,000.00 or imprisonment for not more than seven years or both.
4. I do not have any money on my person, at home, or elsewhere which could be used
for the expenses of this proceeding.
5. 1 do not own real estate. My only assets are
S< ('~.
fltllA..d2. fmAUi.-<M.
1 have no other assets. 1 am not owed any amounts of money by any person.
6. I have C) children: [name], age 1/-. 3 SaW\tA.i\~) fo..c.he.l
7. 1 am presently employed atD bY'~"~ / kiN: I< wAY
/ ' /
My social security number is 1'1~ -7 rl. .-7/.f 9?
1 have the following income: $ 1300, dP /~tt;:... .
My monthly expenses are as follows: I?R.,^* I -tltJ;:..: c... -tf1 j, ~UI.--
1 understand that 1 have a continuing obligation to infonn the court-tl'4~rr:e:
8.
9.
10.
11.
jn our financial circumstances which would permit us to pay the costs incurred herein.
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CERTIFICATE OF SERVICE
...
.'
I, Lori A. Sullivall, an authorizcd agcnt for Martsoll, Dcardorn~ Williams & Otto, hcrcby
ccrtify that a copy ofthc forcgoing Pctilion to Procccd In Forma Paupcris was scrvcd this date by
depositing same in the Post Ofticc at Carlisle, P A, tirst class mail, postage prepaid, addressed as
follows:
Merrick & Fair
1408 Holly Pike
Carlislc, PA 17013
MARTSON DEARDORFF WILLIAMS & OTTO
BY~'Jt~
Lori . Sulliifan
Ten East High Street
Carlisle, PA 17013
(717) 243-3341
Dated: June 26, 1998
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,
(This proof of ~nrvlC(l MUS r Lit:. Pl.ED vVI nflN TEN (Ill) DA VS Ai- fEn fi!rn~J Iho t/Dflcu 01 :lflpt}ld. Chuck tl{JfJlic/J~"Q bOKOS)
PROOF OF SERVICE OF NOTICE OF APPEAL AND RULE TO FILE COMPLAINT
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF,________.____________~_ ; liS
AFFIDAVIT: thereby swear or affirm IMII serverJ
o i1. copy of the Notico 01 Appenl, Common Pll'Wi HI) ______"'.._._ ' !,JpCln HI" Olslrir.t .Iustir;e dosiqnatcd ttlCrein on
(dllla of 5ervica) __ , [J by personal scrvlC(J [] Ily Iccrtili'1dl (registered) mail. sender's
reCi~lpt attach~[1 herr.to. antlupOfl the appellee. (nama) ______________~_____ ' on
_______..___ . 1~L___._ 0 by ;.F~rsonal ~;ervicc [] by (ccrtilled) (rcgistmt~d) mail, sender's receipt attachod hereto.
LJ .1nd turtnm that I sorved thp. f1ule to File a Complaint accompanying the ,1bove Notice of Appaal upon the <lppellee(s) to whom
the Hulf~ was addmssed on _____._______'__' l~L__~ 0 by pur~,orh'tI s{)!"vice 0 by (GCllihHd) (registered)
mail, fAmder's receipt attilched h~relo
SWORN (AFFIRMED) MID SUBSCRIflEO BEFORE ME
THIS
... DAY OF __._.._,19_.-
Signature of affiant
.__.._--_._-~-~._.~_._--_._------
Siglwture of offlClll: tJt)lor0 wl:(>.r: <lff';},I'/,:t Wd.'; 'I't.tJ,)
Til/ll 01 offlcinl
My COlllnlissl(;fJ orplres 0")
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COMMONWEALTH OF PENNSYL VANIA
COUNTY OF: CUMBERLAND
NOTICE OF JUDGMENTITRANSCRIPT
CIVIL CASE
PLAINTIFF: NAME and ADDRESS
'MERRICK &: PAIR "1
1408 HOLLY PIKE
CARLISLE, PA 17013
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Mlg.Ollt.NIJ.:
09.3.03
OJ Nlme: Hen.
SUSAN K. DAY
Add,,,,, 229 MILL STREET, BOX 167
MT. HOLLY SPRINGS, PA
VS.
T'~pho".: (717) 486-7672
DEFENDANT: NAME 'nd ADDRESS
fHALABI, SAMIR
30 N. ORANGE ST.
CARLISLE, PA 17013
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Docket No.: CV-0000036-98
Date Filed: 2/23/98
17065
SAMIR HALABI
30 N. ORANGE ST.
CARLISLE, PA 17013
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THIS IS TO NOTIFY YOU THAT:
Judgment: FOR PT,ATN'I'TFF
Iil Judgment was entered for: (Name) M1mRT~ll' &. 1>lI.TR
Iil Judgment was entered against: (Name) 1l'1I.T.lI.RT. R1\MTR
in the amount of $
474 4<; on:
(Date of JUdgment)
(Date & Time)
o;!2A!QA
. .
o Defendants are jointly and severally liable.
o Damages will be assessed on:
.
Amount of Judgment
Judgment Costs
Interest on Judgment
Attorney Fees
Total
$
$
$
$
$
431.95
42.50
.00
.00
474.45
o This case dismissed without prejudice.
O Amount of Judgment SUbject to
AttachmenVAct5 of 1996 $
o Levy is stayed for days or 0 generally stayed.
Post Judgment Credits $
Post Judgment Costs $
------------
------------
o Objection to levy has been filed and hearing will be held: '
"......
Date: Place:
Certified Judgment Total $
f
Time:
.
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ANY PARTY HAS THE RtGHT TO APPEAL WITHIN 30 DAYS AFTER THE ENTRY OF JUDGMENT BY FILING A NOTICE
OF APPEAL WITH THE PROTHONOTARY/CLERK OF THE COURT OF COMMON PLEAS, CIVIL DIVISION, YOU
...., , . ',' .. ~ . . . o. . ,....,. " . '. . . . ... .. ,..' , . . . .
,', MUST INCLUDE A COpy ,OF THIS NOTICE OF JUDGMENTITFiANSCRIPT FORM WITH YOUR ~OTICE OF APPEAL.
; '.~ 5(F~/19E;: Date ",.., , : " , :', ~i'i~'~~'Br~:;'~ifiS\iCe
".. . :r::;th'a; ;I;/s is a ;ru~ and correct copy of the record of the r ceedings co~~~~:1~1~;:(-r:'\>\lt
1 I ..... " 1,/..- .;a 'lo.. ~.:.o
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.bJ 2k: 0 f-' Date :~,:,,: i f. " I!listtict JLi6ticE
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:t. ;,1:' j".,~"r,;'",:,; .~,. ~'t;;,,~
'~.~\, SEAL '.,-;.~"l,t
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My commission expires first Monday of January,
2004
AOPC 315.96
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