HomeMy WebLinkAbout07-1406c.,?\\(` I 07-I+f01o Civil Term
Cc? S?'e ? ? ?t
nou? 5 C\ ?$? ? c? ?\\
YOU HAVE BEEN SUED IN COURT. IF YOU WISH TO DEFEND
AGAINST THE CLAIMS SET FORTH IN THE FOLLOWING PAGES, YOU MUST
TAKE ACTION WITHIN TWENTY (20) DAYS AFTER THIS COMPLAINT AND
NOTICE ARE SERVED, BY ENTERING A WRITTEN APPEARANCE
PERSONALLY OR BY AN ATTORNEY AND FILING IN WRITING WITH THE
COURT YOUR DEFENSES OR OBJECTIONS TO THE CLAIMS SET FORTH
AGAINST YOU. YOU ARE WARNED THAT IF YOU FAIL TO DO SO THE CASE
MAY PROCEED WITHOUT YOU AND A JUDGMENT MAY BE ENTERED
AGAINST YOU BY THE COURT WITHOUT FURTHER NOTICE FOR ANY
MONEY CLAIMED IN THE COMPLAINT OR FOR ANY OTHER CLAIM OR
RELIEF REQUESTED BY THE PLAINTIFF. YOU MAY LOSE MONEY OR
PROPERTY OR OTHER RIGHTS IlvIPORTANT TO YOU.
YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF
YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO THE
TELEPHONE OR THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU
CAN GET LEGAL HELP.
CUMBERLAND COUNTY BAR ASSOCIATION
32 SOUTH BEDFORD STREET
CARLISLE, PA 17013
1-800-990-9108
717-249-3166
w form 4 • 185
(IN THE COURT OF COMMON PLEAS OF
PLAINTIFF,
(l .?7? '?(Z ;?U1 COUNTY, PENNSYLVANIA
V.
(CIVIL DIVISION
0 (NO: Oq- ILIDlo Civil Term
DEFENDANT.
COMPLAINT IN DIVORCE
AND NOW COMES, the Petitioner, by FILING PRO SE,
who files this Complaint in Divorce a statement of which is as follow:
1. The Petitioner is" 4OhALAS L`7NkMRA-Wl ?\ , an adult individual currently residing at
2. The Defendant is 1 UA?C X-V , an adult individual currently residing at
i` Yr?1^•.• v
3. The Petitioner has been a bona fide resident of the Commonwealth of Pennsylvania for at least six (6) months
previous to the filing of this Complaint.
4. The Petitioner and Respondent were married on date: iA --?) 4n the State of
5. There (is) are JL/5-- child(ren) born of this marriage. Name(s) KA ?I
Birthdate(s): M\
6. Neither party is a member of any branch of military.
7. The marriage is irretrievably broken.
8. The Petitioner, - respectfully requests this Honorable Court
to a grant this Divorce pursuant to Section 1 (c), or in the alternative, Section 3301 (d) of the Divorce Code.
I verify that the statements made in the Complaint are true and correct. I understand that false statements made
herein are subject to penalties of 18 Pa. C.S.A. Section 4904, relating to unsworn falsification to authorities.
Dated: (` ; ' 1
I -Z N, \V10qz
Telephone:
1
tentionally left bank'
,his page in
form 5 • 187
4. (IN THE COURT OF COMMON PLEAS OF
PLAINTIFF,
( A COUNTY, PENNSYLVANIA
v.
( CIVIL DIVISION F'Ao.. '\y
cog (NO:- ?y
DEFENDANT.
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
) ss:
COUNTY OF:
Before me, the subscriber, a Notary Public in and for said Commonwealth and County, per-
sonally appeared {-J??O?IA??\? C%!.%1'.A0iL , who being duly sworn
according to law, deposes and says that the s contained within the foregoing Complaint in Divorce
are true and correct to the best of his/her knowledge, information, and belief, and that he/she is
authorized to make this Affidavit.
IC j
Name
Sworn to and subscribed before me this
I??day of MOff_?- , 200
0 OOw4 4? 6J_V
NOTARY PUBLIC
P!OTARIAL SEAI
CLAUDIA A BREiNBAKEP NCT,AI'Y PUBLIC
Carlisle Boro ^umbedand r?o;m;v
My Commission. Facplres April 4 2009
This page intentionally left blank.
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY,
PENNSYLVANIA
'Q laintiff
Vs File No. 07^ 146(o O-iyil Trip
IN DIVORCE
\ Defendant
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 after the entry of a Final Decree in Divorce dated ,
hereby elects to resume the prior surname of C C , and gives this
written notice avowing his / her intention pursuant to a provisions of 54 P.S. 04.
- ,
Date: \ 011
Signature
Vagjp?tuirje of name i resumed
COMMONWE TH OF PENNSYLV
COUNTY OF "?Cwo?'
On the j day of , 200 r, before me, the Prothonotary or the
notary public, personally appeared 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. 0j
11
1 4??
i+!OTARIAL SEAL F Notary Public '
CLAUDIA D BRE`FNBAKER NOTARY PUBLIC
1,31 iislr Bom Cumbedand County
my ? ommissior Expires April 4 ?W9
CL O
es
FLY'
cr,)
g
??
.?-1 ?? cx? L t d
r
N ?. S
PLAINTIFF,
v.
form si • 201
(IN THE COURT OF COMMON PLEAS OF
(
(>?UL COUNTY, PENNSYLVANIA
(CIVIL DIVISION
l
DEFENDANT.
CERTIFICATE (PROOF) OF SERVICE
PLAINTIFF NAME:
of the Commonwealth of Pennsylvania, he by affirms the fol ing statement under penalty of per-
fury:
1. I am the plaintiff in this action. I hereby certify that on %qc\-,
200 (DATE), I caused a copy of the attached:
NAME OF DOCUMENT:
to be served upon
Defendant's NAME:
ADDRESS:
by depositing a true copy of same enclosed in a post-paid properly addressed wrapper, in a depository
under the exclusive care and custody of the U.S. Postal Service within the Commonwealth of
Pennsylvania. \
Dated: ?? ?.
NAME:
Plaintiff.
Ct,kC?aA \-rnsA\
This page intentionally left blank.
ca C= c>
r `T
A
c?a
E
o
z
=. 1
uE
_ - v o
' v 7
J d
r
?f
C
z
M
•J
U
y .- V
V
c
v 2
T 9
W
y N < N
C Z Z ffi
?s
c N C
Z U ?-
G
c6 ? 0 ? N
63.E
2 x - r c
a G y. >
Z
?L
? T r
V Lj
U •?
V -
a
? Q
f
r
t
l
k
W,unMvco?m >? 42 > ! O=v -v$d-c4 n D,m ncyq N
LL o
U vs aE?`'p ?•Dm WCa UT ?,C??WT? va.- tV sa =?:E P-0 n-+. DN.!W
°.6 IIO _ L. W L-a _ .OL?V r a: L._ Un. T Cr CC. D_ >L
O>°p?Y OO ??oL?Ny Op•°wQaioc+wsomLa qF - EmuE
Z °°?a•?u??t°va> Z>?TdY'Du„?.nm °c.CUEi 4'? o o
0=J3s dhd=NnWLW.u OVA o.: p-c nvi 10 _ W,d®tY O z eL?ap..°Q, a avc TE L Y
W>ud c - W _ := c._ ..'JVd[V?_ II uuivLT?o a°m
?'D> W-9.O ?? ?U6-WOG ®°>Of C-N.a W'^.°c °-O WQN .O >V O>NW?> m a.a+?4°.D 0^i5
d
0- ¢.a
d)-d ? 4dU? ?W? 7V^OLV m 04 a O ????i'aV +-W C
S d'.?LII>Vs d WWL; T3 •'?N Wdyd?;0 L0"'-= -L v M 6`-!•
U E,v TQ D1LaoooW ?uyv°T m Tu>c LQJ paW?U p....mcyc.o?ai°°WOO CeL
EvLe Ld, ?'n u+o>++ n=-`??)oQ.?od oa aci LL"O Oc'm 5 E 0a>;. avrooop;°v'?y i°•eF O'
u=av?°^cd? L?W> vnnc vo dm0? own r.vdL>asv v v
413ep??n a? W OO'OOL c3^o •O e=d?O0vU mO O..'.+O W+L-NJLNON?CY Ya OW T W a°d
R2 6 Q a WDta?V CV FUN®NQnL mO='O am C_C,p20 dOG'OOa 7m3:°Wp600C0.'N?en
E'aUN2]O N EQ+.a'aG O
.._ wa M=?+T3 -.a aUt C_ of
o av
C >¢ >u
a rY a m d
>-W y U N
o ZJ D,u ?v in
Q NM
SA U C' 4? Z'O' o
r-T
=nZW=NU?Ldc
^SLL Q
W Dc
CL
C QK0
° O W O y? W av
Z Lido
G CCD •p of
QZ pnjpV.pn p""
n w QU'.n^aN
' ?? V y °° C ° W W D a° d W 0 Y N U 0` O C
Z W O W O U o W p,U 6 +° ?` 7 m N a°i 0 °m c O u N C E. LL m F
ya wrdz SELL LW°rnv?E a da WD wvcn°? dad
LL Ix ..ZC a"ooDO+?N ,?°Q.'o O O= OOQEO` oo° +,
F LL W dct NU O1m ooD DQ `c > ° d,=U
?XOZI'1J'" 30t„' W NtN O ut ° w s w° O °U NU W 03 W i
LLZJW?Wrn?nc+d !2-a J? Q?"?UO^Ywo W
O Qum.c c=?Ov'O WQ+o O°= }E Zo?F `2=0° U
Wes' ZW °3u c E=>m5c -?o xMu Ou.-+a1- 0`c1
2wzuW Euo- °°wo+o°6a+tdmt Y=LOQ OQ N_z 3m oU
° =m9= ovQvcc'-'TULLE axMov= =m U_ .3 O^
ORenZ?n u> °WTUdi??LO,?°°13 ?••yN0 °U'U' z=DD :- ugi
Z joz _j LL NWODE Et l-, 7-1 asaOOOW Ov Xa••v L-o>u'inO°?3
"MO 0Oc ye y?Nt O °- cJC ¢L'° VOa'CL Lye°
Q O Z T d c U+ ` C G- m d ° W f a L L y C ?• r IL F L g Q? t L
4=Euv:EvomGovOI L WQ .?d ???n°u°e??a v dvWLCv
F? Oo? t
Z=+ OW dO6 COr _7Cli r LW?y?-C =Q CVI?OC
E{ U
o oU?aUQ a.nsm.o W-U o as E°01 LL `w ua->F 6ZO
k E ?!
Ca
4 ?
Uw:
ai a e
,t5e
3 Y
=_ uS
O N
ZN
Ur
Jo
O
Q
p6 T?=+T- mT0 D ° ri Z W ° w° am
c F NoivOc o+v-> > +oscmu°'^c oLO....9po U QLY Qo Ix W 'Q U? 'c
O u+O> >• F Q R Z a >Q WU
aGwWo°Eo 3iv wd"E » ° n?°=}u+cm y? FLL°ao u~ o>zWw< a a an ?d
NGV1??'uU HaOL?LC -N'IIL n-°CDOC-_ CD O WOWWC C F-QS Win Qyj }w WU
QZ<wLLLC` dr m t2 O a "o>o•?yu=NOOS°mcunEQ a UOWLL'OWWS` 3ZJOWJUB ZJt,o uD vMi
Zzsw Otoa.°n O,,w OU Ut+-u. >•dpcc?o ?iUw? ~Oa WLLOZzLLLLOQWWOZM y°UQr^'++°Ta °
ZOF"Uo3.dc ?Uyy?>'O?'??mzonvv`d.=y=» wDm Y? W002FJQOWOQWwwLn2N?w2ivyc°'c `.
mUQLL°NOCN?NOatZCOOL D+'TO °oLw O}=0F_370Z S?QLLmWQ??^jMN^"-QU°.:a
OQFFV LO O=o den d dT-WaT-oE}? J3 LLWOOZZFOZOUW?WC QQ`c 0"U&&wO O:E _j I— E WE
azE a C.2 3: >- y°.60?L+ dddc D 3OON0OEj>V'?O OJ ZQOW?U WaOQW OZJLL O} LL W?
QylY.1 <Lp`?
QO QUwW T°
_ ILWOpLCOE,D -19 -_ Dv.«.O n m v d.« d d' 0 dcT vijO0a=LLLs!2-O},-0MU Z <z sc0.
JF w ornom-W `o ??v ?o=cc`s moo Ewotvm OOOZWF->7Y3W 1-uFi? JM $O -C°n
y WOC9Ua E?a°rur d°uQ 0 }""Ewu"o. LO.E c o w• Or c c d O QOOOQWOMM--im O2UW ? N iQUe en e°?aN
3-t(9m$u°mav°3 _°aa 3m° d>3s}:-n0D_aT F}UFLLa¢ aaaF-?
e
1
_
-
•
° Wo aU
' Q r U_ r c
Q dd
Ln>F Q >Q >U
w W Z a as QW S
UNzQN- }W6 YC N
>WL Fn
ZJOWJ uW M
wQ.nLL}V NmOQnn `Lc
t9lg? ?WZo OLY "-'nL ogd c
FJaZZW `pNUQ LNI+fd o.
00.wwwv'SNZLL =r UC d c
QLLmw_"I???v dUC Oda
'LLO?IWL?wG QdC OO?GWInO
O}LL10ZJlL O}D QTY<y avD
FGQ WW LL LWNOOW
:E D aM *L
w= w O N N ? Q U VIn a N
aFUIY In ° + C O C T =w
Q w W L Job Do . oZ =t.)Ec c =+013
w W O am .Q d 2 F _ WI-- `c z° d C° ° W;
J M,4z cw=m m LLWS WW O.= UUJ NU RA nON4,U
LL ZOZ3Q +dQ mom 0-.8. M WDU'0W in dvcNLL OL-a`ec
Z}3LL-nQ0WQ-m2Jd° Na3 3 J tYmwJ aZjOEc?a°t
OFQ?ZOOZmmU Ua0`L QWCdZvu' OOOOmJ °aod°o*VlLD?°
_
ZJ pJJYQ Q 2+`?-U H? ZOZJO `0- U M°o2n?
OZv_WWZ(LLQ°W.wW.Oxa& 6aZ LO F_ O_JLL vWw+o °a4°ea`r??
00 vU,*n mm F-dvv mLnQZ mmf-F3:0 d °ci+>°i°..
UU ZO>QOOw< .-<o.D uW3aW°QON W*OaOW OLL°OVUlvi=c+
OU,6OLL FFzw-'W °mOWOMW= Oz, W. OWJ:won c2rn+U Uo Nit p°,i
LYaJ_NUQ6>w-:E N:E N=?OZQmL?W-oN¢QOLLCa mO+Lmy+L D.. NZ wY,
OQ>_OFl73 S dcLcOmQUFO W^'GQ'mZMO d>E`- Z pINtt
vO UZ Z?ME, Wm OW3°m°OWZLLi+°d Oivaa QQp>LL Wm d>}DV°oO°+a o?3>
W O00020 V
=c ?- OemWQQO D?yN++p? .OOt
F ?OaQa 3a 3,a2ia pxaw^?'z3?20ut-z Kiu o?'^?m v-ti `mEc?c
Z U Z F MW C O C 6 W L C~= C t d 3 C w F Z W Z Q O 2} O O H of 'Ott p Q Y
-SUYmYIDmUO UD.?UOYz QJWFLLF U=aDav3.E-Qt
Wdd
°Nv =
O cQLmd ?•vII,:,dd=vNN? av mcWLood<
- cLCOad N tj
WOaW :Eli ° Wuta d TO
O-
to
voT eny 'a TV.+ri
-,- u
p waeNVL
aW }uoW o`=
D
1k
O
U _ _ LL
pZmo
m+ 3>
__
o
•E
Q ?a0C.W°+ace0?°Ec'd"m?FCN+oc EDno3N ='Ot
O
•
C
W
.r
n
V L
C T O d-+
C°
H
W
X Dt C
Ld P= U Ud
LL
O
LL a
aE n c
1 - c aL
= 6 L c E.-2 D O v W
U L "O d = O C J D V d •O
cJ
-
>M`? ° Ta
E M
.r W °
?Q+
V
?.O
LL
i..t p
j
>•?
'
6
= OEOL Ci NL
J
Uc+D O
" +
>.
+
E
O
O
L 6
a0'-"v°E O
Wyo •n
*L"a
M
oL°d
O °
"°c
a a
W 6- 0D•aOOn°'OW y
lny-C+U
u
E 3:
-
W+
?
I
II
W
O? C=?W>•pU+.°TWCOa+a>LOiOV.a>CUO•r°?3°d=
-C•Om Voo?-dNG
¢
W
N
L OC
Qzudi°
1L+- FOWLLWW •ri OOCUWjOE-II??c3cEo=n????+m=o=
W
QUV En-ox O c
u. ?
dm
GUeC OU
3
?QLdO
j
J
UT?30 L
?•
-L
..c o.?N..-cm.?ca 030
00J?_,
WE
LL „
„
m
°
z
N
i
l,°yxddv mans o? ?WC? 3vZZ
WZ~M_oc.?U=°m
3, w- wz: E
3
e awo°E n-
QL
, pY °s
woFW
Z>•uQd =+ua?.e-°?'oL d.L°?cu•=3an?uc?aao°uOmm cnQi
ZRZ
d
o
-
d +
ac=
tt
.`Ub ,U
6
E C
SD.6J °jtd
UWC+ov
Fc u
071°n acyu
L Dy
m
-
c N-
CC
=O GW MNOLOOmQ6
CLTO GCin CL3=°-C t O=
D..- p.?vD..av `w
O cEs 3_
- L
c
ZvdOindT+ydy C
ZJCO?L VO =
C
N p°??aN°aaW Omd CL O?YI ."OU1 OCLEG°L•
HaQ O?U ta3ULOU
LF+WdO+U?IIa pj WW° D cQ
o.
}?htu Uc?Ft=WOLI-?°Ed cF^ MTWF d.-UWWU3+'
W Udv a'd
NUOd° d-NE
N W
•
_
D ?U° Cci'O ?
uWmt+
a
i +
F'0UPt O
aJ
°
°•uO L
OO ?
-d=E DO ? >--ate dO Vi-p0 ?°inQ=F-
uo. Qdddl
oEOB3o v?W -Qa`mEoaoW
- 6
L
o
3
IIC
va
n
+ow0_QooELO-_
+ n
>
O
ooL
vu>az 0
nc
od oL o-a.?vino-t d
-
oDUU _
-
nLuFUn`L f-acoaII...=m3n
oF a3 m."ovo+cL
O a- d
3 v°3E
03:
vco .__w
+ c lw
.?W. 'on?Nm aT
v0 aWV D x o- v o
-00ac.wt
m*Ep ..a
c-Dd ER O W>.'d
o=L ?E-ds oQ md E+
wd c
° °,Wnccct m'^+v v
...
D v a
a
} Woafv o Way
d
W?oLvc dLE°MW
D Z-5 O y T'n
W
LE N 0-000
M
U+ v y O
low
dOt
mEvueo u a°
c Lo=??aaE
W C- d c+
°
U
U<=U--TN oyW O?o UCDC
V 02ma ° ua•O"v°?dW5M:E W O edteU?
W
? O-?dy
d?N
a
OZ •O d E
G^ ° v L
Zw
a
0
®O °D W,D?O ^
?
'
=Z
pC W O G?'3 V Cw
QW O
Z
Of'6 E>
C ao N u't C
p.L-y?0
a>'udi
Z"6PT?.=+-CR
s 0?? O'
.6
S
D W.° W+ W ®
N
amO
T coWEo
a c
FaEwvOECT ?Q W
?i>,
F<[L- n=dDE .°dO O
h FypO
W ?QON Om>mp,N
o
,
f'
a
..
CyrcE ^r aEWa..-.Eu°LOa+
F .
C
Jd Wi
4
r
d
° (rEvUOrnWWE
°
J
FWD oW?cWW°a
LL;-W?UCUi°W-'U
gip ecae n a; ?mmY CV iny?
I v
u. woCOe
c
ie
yoW?iinw+
WFCOa awvwn .vux.T 6:?Ea ..OC
.
-Ep nau
:E
mcmLO c
LL e?c?3
W::-5
m
O
Q'
i
i3
m
C
•O E=Py a
O?= 'n °mro-WOW.°.. °C2 CF_-e ° J=
..-OL.rw
WOdomL>N T
V
W Na?.=.2ES
0.0 ,a >
®rv
L?t
i
?L L
E
D
Ul
t a?ds
=
v
°
=d ;
n-
. +m3aN enc
rncW °3
ow
w_0
F° ov W=,.,
E ud°W3=
wo od C ?WEEg`a
•s'f.o s
U
a..LL O d o
.- cuit W•c
.D
..
a
i
t
O
E`-'-O
° l
LE L m
d
J
d? -
JVWLWV
Wo 'U+E
?? o
O
t
Wo W
.. a-10 _j
cON ' Jatooc°o
I U
D
Ta
li•
°2Q
+
_°
e.Ournc mn}m ui
s
C
t
Y ?UMaII0. y
:
p
M.
L -w?k6 ccadm
4 =?•Cc-E
?_
C]?-+
? _a
r
:
??.? .? r
? ? ?
? %-mac°.?
?
? c:
' t
! GA? _
? .
..
FNJ "t7
PLAINTIFF,
v.
form 16 + 213
(IN THE COURT OF COMMON PLEAS OF
(
(CUA COUNTY, PENNSYLVANIA
(CIVIL DIVISION
\ N\? e_- dc, ? -?
?OCA (NO: o) viw,
DEFENDANT.
AFFIDAVIT OF CONSENT
1. A complaint in Divorce under Section 3301 (c) of the Divorce Code was filed on (date:) CJ3/k-S/
2. The marriage of the Plaintiff and Defendant is irretrievably broken and ninety days have elapsed from the date of
filing and Complaint.
3 I consent to the entry of a final decree of Divorce after service of notice of intention to request entry of the decree.
WAIVER OF NOTICE OF INTENTION TO REQUEST
ENTRY OF A DIVORCE DECREE UNDER
SECTION 3301 (c) OF THE DIVORCE CODE
I consent to the entry of a final decree of 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 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: Q11 /?CD
ra C?
intentionally left blank
This page
form 17 • 215
Q \ "D -\ ? I 1
PLAINTIFF,
V.
(IN THE COURT OF COMMON PLEAS OF
(
(C Al M\RS COUNTY, PENNSYLVANIA
(
(CIVIL DIVISION
(
(NO: C3
DEFENDANT.
AFFIDAVIT OF CONSENT
1. A complaint in Divorce under Section 3301(c) of the Divorce Code was filed on (date:)/-./ Q'-7
2. The marriage of the Plaintiff and Defendant is irretrievably broken and ninety days have elapsed from the date of
filing and Complaint.
3 I consent to the entry of a final decree of Divorce after service of notice of intention to request entry of the decree.
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 of 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 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:
Defendant
()
D
J
re.v r
?1d
This page intentionally left blank.
A '*4 I AN'
e Order Confirmation
?. , I)atr*ot W
Now you know
Customer Orderer Account Number
Saylor, Stephanie 122472
Payer Payer Account Number
122472
Ad Order Number 0001661155
Sales Rep. jnorth
Order Taker jnorth
Order Source Phone
Special Pricing None
Saylor, Stephanie PO Number
535 N. 2nd St. Ordered By stephainie
Lemoyne PA 17043 USA Customer Fax
Customer Entail stephanie@suscom.net
Customer Phone 717-764-1271
717-586-2368
Paver Phone 717-764-1271
717-586-2368
Tear Sheets Proofs Affidavits Blind Box Promo Type
0 0 1
Invoice Text
Materials
Total Ad Cost $44.02
Payment Amount $44.02 Payment Method Credit Card - VISA:2688
Amount Due $0.00
Ad Number Ad Type Ad Size Color
0001661155-0' Legal Liners : 1.0 X 8 Li <NONE>
Production Method Production Notes
Ad Booker
Product Information Classification # Inserts Run Dates
PNCO::Full Run 812-Miscellaneous Legal NoticeE 1 3/28/2007
Run Schedule Invoice Text
ATTENTION DOUGLAS CLIFFORD LOISELL (UNKNOWN LOCATION) Stephanie
3/28/2007 8:42:15AM 1
THE PATRIOT NEWS
THE SUNDAY PATRIOT NEWS
Proof of Publication
Under Act No. 587, Approved May 16, 1929
Commonwealth of Pennsylvania, County of Dauphin} ss
Joseph A. Dennison, being duly sworn according to law, deposes and says:
That he is the Assistant Controller of The Patriot News Co., a corporation organized and existing under the
laws of the Commonwealth of Pennsylvania, with its principal office and place of business at 812 to 818 Market
Street, in the City of Harrisburg, County of Dauphin, State of Pennsylvania, owner and publisher of The Patriot-
News and The Sunday Patriot-News newspapers of general circulation, printed and published at 812 to 818 Market
Street, in the City, County and State aforesaid; that The Patriot-News and The Sunday Patriot-News were
established March 4th, 1854, and September 18th, 1949, respectively, and all have been continuously published ever
since;
That the printed notice or publication which is securely attached hereto is exactly as printed and published
in their regular daily and/or Sunday/ Metro editions which appeared in the 28th day(s) of March 2007. That neither
he nor said Company is interested in the subject matter of said printed notice or advertising, and that all of the
allegations of this statement as to the time, place and character of publication are true; and
That he has personal knowledge of the facts aforesaid and is duly authorized and empowered to verify this
statement on behalf of The Patriot-News Co. aforesaid by virtue and pursuant to a resolution unanimously passed
and adopted severally by the stockholders and board of directors of the said Company and subsequently duly
recorded in the office for the Recording of Deeds in and for said County of Dauphin in Miscellaneous Book "M",
Volume 14, Page 317.
PUBLICATION .............. . . . . .. .................................................
COPY Sworn to an ub i beforb%thi?gk&d ???V D-
n
Notarial Seal
Terry L. Russell, Notary Public
City Of Harrisburg, Dauphin County
My Commission Expires June 6, 2010
Me r PRnncvlvanl Associ io of Notaries
NOTARY
STEPHANIE SAYLOR
535 NORTH SECOND STREET
LEMOYNE, PA. 17043
C)
J
VS.
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
CIVIL DIVISION
ppvtqJ NO. Q?CIVIL TERM
PRAECIPE TO TRANSMIT RECORD
To the Prothonotary:
Transmit the record, together with the following information to the court for entry of a divorce decree:
1. Ground for divorce:
kc)
330T(d)(1) of the Divorce Code.
(Strike out inapplicable section).
2. Date and manner of service of the complaint: M?,&L:a ano ?
3. Complete either paragraph (a) or (b).
(a) Date of execution of the affidavit of consent required by §3301 (c) of the Divorce Code:
by plaintiff
; by defendant
(b) (1) Date of execution of the affidavit required by §3301(d)
of the Divorce Code:
((2)) Date of filing and service of the plaintiff's affidavit upon the respondent:
4. Related claims pending: *onQ T,
5. Complete either (a) or (b).
(a) Date and manner of service of the notic of intention to file praecipe to transmit record, a
copy of which is attached: 02 w " ;?A
?% ?\ Czc? a°\ \ O'c!) Z
(b) Date of plaintiff's Waiver of Notice in §3301 (c) Divorce was filed with
the Prothonotary: (, r? - col -
Date defendant's Waiver of Notice in §3301 (c) Divorce was filed with
the Prothonotary:
Attorney for Plainti efendant
s Fri
c C-0
7'