HomeMy WebLinkAbout00-05405
IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY
STATE OF PENNA.
KEITH R. MILLER,
Plaintiff
VERSUS
BERTHA MILLER,
Defendant
No. 2000-5405 CIVIL TERM
DECREE IN
DIVORCE
CIVIL ACTION - LAW
IN DIVORCE
AND NOW, 2001 , IT IS ORDERED AND
DECREED THAT KEITH R. MILLER , PLAINTIFF,
AND
BERTHA MILLER
ARE DIVORCED FROM THE BONDS OF MATRIMONY.
-DEFENDANT,
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;
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The Marriage Settlement Agreement dated December 29, 2000 and signed by
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MARRIAGE SETTLEMENT AGREEMENT
THIS AGREEMENT made this 0' "$ay of ,k2000, by and between
BERTHA MILLER, (hereinafter referred to as "WIFE") and KEITH R. MILLER,
(hereinafter referred to as "HUSBAND").
WITNESSETH:
WHEREAS, HUSBAND and WIFE were lawfully married on August 2, 1986, in
Newville, Pennsylvania; and
WHEREAS, diverse, unhappy differences, disputes and difficulties have arisen between
the parties and it is the intention of HUSBAND and WIFE to settle fully and finally their
respective financial and property rights and obligations as between each other, including, but not
limited to the settling of all matters between them relating to the ownership and equitable
distribution of real and personal property, the settling of all claims and possible claims by one
against the other or against their respective estates, and the equitable distribution of property and
alimony for each parry; and
WHEREAS, the parties executed a Post-Nuptial Agreement on August 3, 1995, which
terms and provisions have guided the parties in the settling of all claims and the equitable
distribution of property and alimony for each party.
The parties hereto agree and covenant as follows:
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1.
The parties have attempted to divide their matrimonial property in a manner which
conforms to a just and right standard, taking into account the Post-Nuptial Agreement executed
by the parties on August 3, 1995, with due regard to the rights of each party. It is the intent of
the parties that such division shall be final and shall forever determine their respective rights.
The division of existing marital property is not intended by the parties to constitute in any way a
sale or exchange of assets.
2.
Neither party shall molest, harass, annoy, injure, threaten or interfere with the other party
in any matter whatsoever. Each party may carry on and engage in any employment, profession,
business or other activity as he or she may deem advisable for his or her sole use and benefit.
Neither party shall interfere with the uses, ownership, enjoyment or disposition of any property
now owned and not specified herein or property hereafter acquired by the other.
3.
The consideration for this contract and agreement is the mutual benefit to be obtained by
both of the parties hereto and the covenants and agreements of each of the parties to the other.
The adequacy of the consideration for all agreements herein contained is stipulated, confessed,
and admitted by the parties, and the parties intend to be legally bound hereby.
Each party to the Agreement acknowledges and declares that he or she,
respectively:
(1) Is represented by counsel of his or her own choosing, or if not represented by
counsel, understands that he or she has the right to counsel: HUSBAND is
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represented by Douglas G. Miller, Esquire of Irwin, McKnight & Hughes; WIFE
chooses not to be represented by counsel, and by initialing this page
acknowledges her right to be represented by counsel A)II --- ;
(2) Is fully and completely informed of the facts relating to the subject matter of
this Agreement and of the rights and liabilities of the parties;
(3) Is entering into this Agreement voluntarily after receiving the advice of
counsel or after choosing not to consult an attorney;
(4) Has given careful and mature thought to the making of this Agreement;
(5) Has carefully read each provision of this Agreement; and
(6) Fully and completely understands each provision of this Agreement, both as
to the subject matter and legal effect of each provision.
This Agreement shall become effective immediately as of the date of execution.
4.
It is the purpose and intent of this Agreement to settle forever and completely the interest
and obligations of the parties in all property that they own separately, and all property that would
qualify as marital property under the Pennsylvania Divorce Code, Title 23, Section 401(e), and
that is referred to in this Agreement as "Marital Property", as between themselves, their heirs and
assigns. The parties have attempted to divide their Marital Property in a manner that conforms to
a just and fair standard, with due regard to the rights of each party. The division of existing
Marital Property is not intended by the parties to constitute in any way a sale or exchange of
assets, and the division is being effected without the introduction of outside funds or other
property not constituting a part of the marital estate.
It is the further purpose of this Agreement to settle forever and completely any obligation
under the Pennsylvania Divorce Code relating to spousal support or alimony.
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5.
Each party represents and warrants that he or she has made a full and fair disclosure to the
other of all of his or her property interests of any nature, including any mortgage, pledge, lien,
charge, security interest, encumbrance, or restriction to which any property is subject. Each
party further represents that he or she has made a full and fair disclosure of all debts and
obligations of any nature for which he or she is currently liable or may become liable. Each
further represents and warrants that he or she has not made any gifts or transfers for inadequate
consideration of Marital Property without the prior consent of the other.
Each Party acknowledges that, to the extent desired, he or she has had access to all joint
and separate State and Federal Tax Returns filed by or on behalf of either or both Parties during
marriage.
6.
REAL ESTATE: WIFE agrees to transfer all right, title and interest which she may
have in the real estate situate at 494 Brickchurch Road, Newville, Cumberland County,
Pennsylvania to HUSBAND and hereby releases all claims which she may have regarding said
real estate in accordance with this paragraph. HUSBAND agrees to pay the outstanding
mortgage payments and hold WIFE harmless from any obligations on said mortgage and
indemnify her if any claim is made against her. In furtherance of the transfer of all right, title and
interest in said real estate, WIFE hereby agrees within ten (10) days from the date hereof to
execute a Deed conveying her interest in said property to HUSBAND which shall remain in
escrow with his legal counsel's office until WIFE'S name has been removed from the mortgage
and any other encumbrance on this property.
With regard to the rental property located 35 West Main Street, Plainfield, Cumberland
County, Pennsylvania, HUSBAND and WIFE agree to immediately list the property for sale and
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transfer said property at a purchase price which is agreeable to both parties. Further, HUSBAND
and WIFE covenant and agree to maintain the property in conditions which would effectuate the
sale of the property as soon as practically possible, and covenant and agree to use their best
efforts to effectuate the sale. Until such time as the same is sold, HUSBAND and WIFE further
agree to be equally responsible for the mortgage payments on said property, and equally
responsible for the related costs to maintain the property, including but not limited to real estate
taxes, insurance, and any maintenance and repair costs. Further, any and all rent monies or other
profits collected on said property will be divided equally between HUSBAND and WIFE until
the sale of said property. After the property is sold and the costs and expenses, including those
expenses outlined above, have been equally divided and paid in full, and no outstanding debt
remains, the balance of the proceeds from the sale of the property will be divided between the
parties as follows: If the sale price of the property is greater than or equal to $190,000.00,
HUSBAND shall receive payment of $10,000.00. If the sale price of the property is less than
$190,000.00, HUSBAND shall receive a payment less than $10,000.00 as is mutually agreeable
to the parties and as is proportional to the difference between the reduced sales price and
$190,000.00. In either case, WIFE shall receive the balance of the proceeds from said sale. In
the event the property is sold and a deficit is due to complete the sale, HUSBAND shall be
responsible for Fifty Percent (50%) of said deficit and WIFE shall be responsible for Fifty
Percent (50%) of said deficit.
With regard to the tanning and nail salon business located on the property at 35 West
Main Street, Plainfield, Cumberland County, Pennsylvania, HUSBAND and WIFE agree to
immediately list the business and its assets for sale and transfer said business at a purchase price
which is agreeable to both parties. Further, HUSBAND and WIFE covenant and agree to
maintain the business in conditions which would effectuate the sale of the business as soon as
practically possible, and covenant and agree to use their best efforts to effectuate the sale. Until
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such time as the same is sold, HUSBAND and WIFE further agree to be equally responsible for
the costs to maintain the business, including but not limited to insurance, and any maintenance
and repair costs. Further, any and all monies or profits collected from said business will be
divided equally between HUSBAND and WIFE until the sale of said business. After the
business is sold and the costs and expenses, including those expenses outlined above, have been
equally divided and paid in full, and no outstanding debt remains, the balance of the proceeds
from the sale of the business will be divided between the parties with WIFE receiving Fifty
Percent (50%) and the HUSBAND receiving Fifty Percent (50%). In the event the business is
sold and a deficit is due to complete the sale, HUSBAND shall be responsible for Fifty Percent
(50%) of said deficit and WIFE shall be responsible for Fifty Percent (50%) of said deficit.
WIFE agrees to transfer all right, title and interest which she may have in HUSBAND'S
hunting camp to HUSBAND and hereby releases all claims which she may have regarding said
hunting camp. HUSBAND agrees to hold WIFE harmless from any obligations relating to said
hunting camp and indemnify her if any claim is made against her.
7.
SUPPORT: It is the mutual desire of the parties that HUSBAND will not be required to
pay support to WIFE and that WIFE will not provide any financial support to HUSBAND. The
parties also waive any right they have to receive alimony payments from the other following the
entry of the Divorce Decree in this matter.
8.
PERSONAL PROPERTY: HUSBAND shall maintain possession of the following
personal property: all mechanical and woodworking tools and equipment, all guns with the
exception of a Raven 22 pistol and Remmington Model 7 6mm gun, a Masonic Grandfather
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clock, two of the glass ball & claw tables, a 4-drawer oak dresser, the oak rocker, the oak
bookcase, the washer and dryer, a refrigerator, the beer tap system, the framed Gerald Putt print,
and any and all other personal property located in the two-story, 28' by 48' garage at the marital
residence. WIFE agrees to waive all right, title and interest in said personal property. WIFE
shall maintain possession of all other personal property within the marital residence, including
the Raven 22 pistol and Remmington Model 7 6mtn gun, and HUSBAND agrees to waive all
right, title and interest in the same.
9.
AUTOMOBILES: WIFE hereby waives all right, title and interest in any vehicle that
HUSBAND currently owns or may own in the future, and specifically agrees to execute all
documents necessary to transfer title in the parties' 1994 F-250 Truck to HUSBAND within
thirty (30) days from the date of this Agreement. HUSBAND shall hold WIFE harmless for any
and all liability associated with the use and purchase of any vehicles he may own, and shall be
solely responsible for all insurance and other financial responsibility associated with said
vehicles.
HUSBAND hereby waives all right, title and interest in any vehicle that WIFE currently
owns or may own in the future, and specifically agrees to execute all documents necessary to
transfer title in the parties' 1995 Chrysler Minivan to WIFE within thirty (30) days from the date `
of this Agreement.. WIFE shall hold HUSBAND harmless for any and all liability associated
with the use and purchase of any vehicles she may own, and shall be solely responsible for all
insurance and other financial responsibility associated with said vehicles.
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10.
MARITAL DEBTS: It is mutually agreed by and between the parties that WIFE shall
assume all liability for and pay and indemnify the HUSBAND against all debts incurred by
WIFE alter the date of separation. WIFE represents and warrants to HUSBAND that since the
parties' marital separation she has not contracted or incurred any debt or liability for which
HUSBAND or his estate might be responsible and WIFE further represents and warrants to
HUSBAND that she will not contract or incur any debt or liability after the execution of this
Agreement, for which HUSBAND or his estate might be responsible. WIFE shall indemnify
and hold HUSBAND harmless from any and all claims or demands made against him by reason
of debts or obligations incurred by her.
HUSBAND shall assume all liability for and pay and indemnify WIFE against all
debts incurred by HUSBAND after the date of separation. HUSBAND represents and warrants
to WIFE that since the parties' marital separation he has not contracted or incurred any debt or
liability for which WIFE or her estate might be responsible and HUSBAND further represents
and warrants to WIFE that he will not contract or incur any debt or liability after the execution
of this Agreement, for which WIFE or her estate might be responsible. HUSBAND shall
indemnify and hold WIFE harmless from any and all claims or demands made against her by
reason of debts or obligations incurred by him.
11.
INSURANCE AND EMPLOYEE BENEFITS: The parties agree that any life
insurance policies on the life of HUSBAND or WIFE or any other employee benefits, including
but not limited to retirement, profit sharing or medical benefits of either party, shall be their own.
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WIFE waives all right, title and claim to HUSBAND's employee benefits, and HUSBAND
waives all right, title, and claim to any of WIFE's employee benefits.
12.
BENEFITS AND BANK ACCOUNTS: WIFE agrees to waive all right, title and
interest which she may have in the savings or checking or any other bank accounts of the
HUSBAND and likewise HUSBAND agrees to waive all right, title and interest which he may
have in the savings or checking or any other bank accounts of WIFE. The parties further agree
that any joint bank accounts or lines of credit shall be closed with no further debt incurred on
said accounts or lines of credit.
13.
DIVORCE: The parties both agree to cooperate with each other in obtaining a final
divorce of the marriage. It is agreed that the parties will execute and file the consents necessary
to obtain the divorce. Any parry who fails to cooperate with obtaining the Divorce shall pay all
the costs and legal fees of the party who is seeking the divorce.
14.
BREACH: If either parry breaches any provisions of this Agreement, the other parry
shall have the right, at his or her election, to sue for damages for such breach or seek such other
remedies or relief as may be available to him or her, and the party breaching this contract shall be
responsible for payment of legal fees and costs incurred by the other in enforcing their rights
under this Agreement.
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15.
ADDITIONAL INSTRUMENTS: Each of the parties shall from time to time, at the
request of the other, execute, acknowledge and deliver to the other party any and all further
instruments that may be reasonably required to give full force and effect to the provisions of this
Agreement.
16.
VOLUNTARY EXECUTION: The provisions of this Agreement and their legal effect
have been fully explained to the parties by their respective counsel, are fully understood by both
parties, and each party acknowledges that the Agreement is fair and equitable, that it is being
entered into voluntarily, and that it is not the result of any duress or undue influence. It is the
parties' intent that this Agreement does not merge with the Divorce Decree, but rather shall
continue to have independent contractual significance. Each party maintains his or her
contractual remedies or any other remedies provided by law or statute. Those remedies shall
include, but not be limited to, damages resulting from breach of this Agreement, specific
enforcement of this Agreement and remedies pertaining to failure to comply with an order of
court or agreement pertaining to equitable distribution, alimony, alimony pendente lite, counsel
fees and costs as set forth in the Pennsylvania Divorce Code or other similar statutes now in
effect and as amended or hereafter enacted.
17.
ENTIRE AGREEMENT: This Agreement contains the entire understanding of the
parties and there are no representations, warranties, covenants or undertakings other than those
expressly set forth herein.
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18.
APPLICABLE LAW: This Agreement shall be construed under the Laws of the
Commonwealth of Pennsylvania.
19.
PRIOR AGREEMENTS: It is understood and agreed that any and all property
settlement agreements which may or have been executed prior to the date and time of this
Agreement are null and void and of no effect.
20.
PAYMENT OF COSTS: Each party shall be responsible for their own attorneys fees
incurred in the settlement of the divorce and economic issues surrounding this divorce.
21.
WAIVER OF CLAIMS AGAINST ESTATES: Except as herein otherwise provided,
each party may dispose of his or her property in any way, and each party hereby waives and
relinquishes any and all rights he or she may now have or hereafter acquire, under the present or
future laws of any jurisdiction, to share in the property or the estate of the other as a result of the
marital relationship, including without limitation, dower, curtesy, statutory allowance, widow's
allowance, right to take in intestacy, right to take against the Will of the other, and right to act as
administrator or executor of the other's estate, and each will, at the request of the other, execute,
acknowledge and deliver any and all instruments which may be necessary or advisable to carry
into effect this mutual waiver and relinquishment of all such interests, rights and claims.
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IN WITNESS WHEREOF, the parties hereunto have set their hands and seals the day
and year first above written.
WITNESSES:
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BERTHA MILLER
2" t? At /,& Py 2yy & (SEAL)
0 KEITH R. MILLER
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COMMONWEALTH OF PENNSYLVANIA
: SS:
COUNTY OF CUMBERLAND
PERSONALLY APPEARED BEFORE ME, this Ijo? day of
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X8 , a Notary Public, in and for the Commonwealth of Pennsylva ' and County of
Cumberland, BERTHA MILLER, known to me (or satisfactorily proven) to be the person
whose name is subscribed to the within Marriage Settlement Agreement, and acknowledges that
he executed the same for the purposes therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and official seal.
Notarial Seal
Betzi A. Morrison, Notary Public
Carlisle Boro, Cumberland County
My Commission Expires Dec. 15, 2004
Member, PennsyNwia Association of WOW
COMMONWEALTH OF PENNSYLVANIA
SS:
COUNTY OF CUMBERLAND
PERSONALLY APPEARED BEFORE ME, this 2q day of
2000, a Notary Public, in and for the Commonwealth of Pennsylvania and County of
Cumberland, KEITH R. MILLER, known to me (or satisfactorily proven) to be the person
whose name is subscribed to the within Marriage Settlement Agreement, and acknowledges that
he executed the same for the purposes therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and official seal.
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KEITH R. MH,LER,
Plaintiff
V.
BERTHA MILLER,
Defendant
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
CIVIL ACTION - LAW
2000-5405 CIVIL TERM
IN DIVORCE
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: irretrievable breakdown under Section 3301(c) of the Divorce Code.
2. Date and manner of service of complaint: A certified copy of the Complaint in Divorce was served upon
the defendant, Bertha Miller, on August 10, 2000, by certified, restricted delivery mail, addressed to her at 494 Brick
Church Road, Newville, Pennsylvania 17241, with Return Receipt Number Z 719 956 056.
3. Complete either paragraph (a) or (b).
(a) Date of execution of the affidavit of consent required by Section 3301(c) of the Divorce
Code: by plaintiff: January 4, 2001; by defendant: January 8, 2001.
(b)(1) Date of execution of the affidavit required by Section 3301(d) of the Divorce Code:
(b)(2) Date of filing and service of the plaintiffs affidavit upon the defendant:
4. Related claims pending: NONE.
5. Complete either (a) or (b).
(a) Date and manner of service of the Notice of Intention to file Praecipe to Transmit Record,
a copy of which is attached:
(b) Date plaintiffs Waiver of Notice in Section 3301(c) Divorce was filed with the
Prothonotary: January 9, 2001.
Date defendant's Waiver of Notice in Section 3301(c) Divorce was filed with the
Prothonotary: January 9, 2001.
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DOU AS G. MILLER, ESQUIRE
Attorney for Plaintiff
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KEITH R. MILLER, IN THE COURT OF COMMON PLEAS OF
Plaintiff
CUMBERLAND COUNTY, PENNSYLVANIA
V. CIVIL ACTION - LAW
2000- 94joSCIVIL TERM
BERTHA MILLER,
Defendant IN 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 in 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, Cumberland County Courthouse, Carlisle, Pennsylvania 17013.
IF YOU DO NOT FILE A CLAIM FOR ALIMONY, DIVISION OF PROPERTY,
LAWYER'S FEES OR EXPENSES BEFORE A 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 Association
2 Liberty Avenue
Carlisle, Pennsylvania 17013
717-249-3166
1-800-990-9108
AMERICANS WITH DISABILITIES
ACT OF 1990
The Court of Common Pleas of Cumberland County is required by law to comply with
the Americans with Disabilities Act of 1990. For information about accessible facilities and
reasonable accommodations available to disabled individuals having business before the court,
please contact our office. All arrangements must be made at least 72 hours prior to any hearing
or business before the court. You must attend the scheduled conference or hearing.
KEITH R. MILLER,
Plaintiff
V.
BERTHA MILLER,
Defendant
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
CIVIL ACTION - LAW
2000-Sy03?CIVIL TERM
IN DIVORCE
COMPLAINT IN DIVORCE PURSUANT TO SECTION 3301(c)
OF THE DIVORCE CODE
NOW comes the plaintiff, Keith R. Miller, by his attorney, Douglas G. Miller, Esquire,
and files this complaint in divorce against the defendant, Bertha Miller, representing as follows:
1. The plaintiff is Keith R. Miller, an adult individual residing at 494 Brick Church
Road, Newville, Pennsylvania 17241.
2. The defendant is Bertha Miller, an adult individual residing at 494 Brick Church Road,
Newville, Pennsylvania 17241.
3. The defendant has been a resident of the Commonwealth of Pennsylvania at least six
months prior to the filing of this action in divorce.
4. The plaintiff and the defendant were married on August 2, 1986 in Newville,
Pennsylvania.
5. There have been no prior actions of divorce or for annulment between the parties.
6. There were no children born to this marriage.
7. Pursuant to the Divorce Code, Section 3301(c), the plaintiff avers as the grounds upon
which this action is based that the marriage between the parties is irretrievably broken.
8. The plaintiff avers that he has been advised of the availability of counseling and that
said parry has the right to request that the court require the parties to participate in counseling.
WHEREFORE, the plaintiff demands judgment dissolving the marriage between the
two parties.
Respectfully submitted,
IRWIN, McKNIGHT & HUGHES
By: `
Dough Esquire
Attorney for Plaintiff
West Pomfret Professional Building
60 West Pomfret Street
Carlisle, Pennsylvania 17013-3222
(717) 249-2353
Supreme Court I.D. No. 83776
Date: August 2, 2000
VERIFICATION
The foregoing Complaint in Divorce is based upon information which has been gathered
by my counsel and me in the preparation of this action. I have read the statements made in this
Complaint and they are true and correct to the best of my knowledge, information and belief I
understand that false statements herein made are subject to the penalties of 18 Pa. C.S.A. Section
4904, relating to unworn falsification to authorities.
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KEITH R. MILLER
Date: August 2 , 2000
KEITH R. MILLER,
Plaintiff
V.
: IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
CIVIL ACTION - LAW
2000--fyOS CIVIL TERM
BERTHA MILLER,
Defendant
IN DIVORCE
PLAINTIFF'S MARRIAGE COUNSELING AFFIDAVIT
The plaintiff, being duly sworn according to law, deposes and says:
1. I have been advised of the availability of marriage counseling and understand that I
may request that the court require that my spouse and I participate in counseling.
2. I understand that the court maintains a list of marriage counselors in the Prothonotary's
Office, which list is available to me upon request.
3. Being so advised, I do not request that the court require that my spouse and I
participate in counseling prior to a divorce decree being handed down.
I verify that the statements made in this affidavit are true and correct. I understand that
false statements herein made are subject to the penalties of 18 Pa. C.S. Section 4904 relating to
unworn falsification to authorities.
Date: August 2 , 2000 eA
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KEITH R. MILLER
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KEITH R. MILLER,
Plaintiff
V.
IN THE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY, PENNSYLVANIA
CIVIL ACTION - LAW
2000-5405 CIVIL TERM
BERTHA MILLER,
Defendant
IN DIVORCE
PLAINTIFF'S AFFIDAVIT OF CONSENT
1. A complaint in divorce under Section 3301(c) of the Divorce Code was filed on
August 3, 2000.
2. The marriage of plaintiff and defendant is irretrievably broken and ninety days have
elapsed from the date of the filing of the complaint.
3. I consent to the entry of a final decree in divorce.
4. 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.
I verify that the statements made in this affidavit are true and correct. I understand that
false statements herein made are subject to the penalties of 18 Pa. C. S. Section 4904 relating to
unworn falsification to authorities.
Date: January 4th , 2001 A k k k4.e?.?
KEITH k MILLER
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KEITH R. MILLER,
Plaintiff
V.
IN THE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY, PENNSYLVANIA
CIVIL ACTION - LAW
2000-5405 CIVIL TERM
BERTHA MILLER,
Defendant
IN DIVORCE
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 made are subject to the penalties of 18 Pa. C.S. Section 4904 relating to
unworn falsification to authorities.
Date: January 4th , 2001
KEITH R. MILLE
Plaintiff
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]KEITH R. MILLER,
Plaintiff
V.
: IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
CIVIL ACTION - LAW
2000-5405 CIVIL TERM
BERTHA MILLER,
Defendant
IN DIVORCE
DEFENDANT'S AFFIDAVIT OF CONSENT
1. A complaint in divorce under Section 3301(c) of the Divorce Code was filed on
August 3, 2000.
2. The marriage of plaintiff and defendant is irretrievably broken and ninety days have
elapsed from the date of the filing of the complaint.
3. I consent to the entry of a final decree in divorce.
4. 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.
I verify that the statements made in this affidavit are true and correct. I understand that
false statements herein made are subject to the penalties of 18 Pa. C. S. Section 4904 relating to
unworn falsification to authorities.
Date: January 8th , 2001
BERTHA MILLER
KEITH R. MILLER,
Plaintiff
V.
: IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
CIVIL ACTION - LAW
2000-5405 CIVIL TERM
BERTHA MILLER,
Defendant
IN DIVORCE
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 made are subject to the penalties of 18 Pa. C.S. Section 4904 relating to
unworn falsification to authorities.
Date: January 8th , 2001
BERTHA MILLER
Defendant
KEITH R. MILLER,
Plaintiff
V.
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
CIVIL ACTION - LAW
2000-5405 CIVIL TERM
BERTHA MILLER,
Defendant IN DIVORCE
AFFIDAVIT OF SERVICE OF COMPLAINT
PURSUANT TO PA. R.C.P. RULE NO. 1920.4 (a)(1)(i)
COMMONWEALTH OF PENNSYLVANIA .
. SS:
COUNTY OF CUMBERLAND
NOW, Douglas G. Miller, Esquire, being duly sworn according to law, does depose and
state:
1. That he is a competent adult and attorney for the plaintiff in the captioned action in
divorce.
2. That a certified copy of the Complaint in Divorce was served upon the defendant,
Bertha Miller, on August 10, 2000, by certified, restricted delivery mail, addressed to her at 494
Brick Church Road, Newville, Pennsylvania 17241, with Return Receipt Number Z 719 956 056.
3. That the said receipt for certified mail is signed and attached hereto and made a part
hereof.
I verify that the statements made in this affidavit are true and correct. I understand that
false statements herein made are subject to the penalties of 18 Pa. C. S. Section 4904, relating to
unworn falsification to authorities.
DOU AS G. MILLER, ESQUIRE
Attorney for Plaintiff
Date: January 8th , 2001
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Receipt for
Certified Mail
No Insurance Coverage Provided'
Do not use for international Mail
(See 'Reverse)
sent to
NS BERTHA 'MILLER
Street and No. -
494 BRICK CHURCH RD
P.O., State and ZIP Code
NEWVILLE PA 17241
Postage $ 1 7
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Return Receipt Showing to Whom,
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08-03-00
KEITH MILD - DIV. COMP.
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so that we can return the card to you.
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or on the from if space permits.
1. Article Addressed to:
US BERTHA MILLER
494 BRICK CHURCH RD
NEWVILT E PA 17241
by (P/eW Print Clearly) 1 J3, Date of Delivery
? Agent
D. Is delivery address different from item 1? ? Yes
If YES, enter delivery address below: M No
V'eh"e'r to addressee owX
3. Service Type
EI Certified Mail ? Express Mail
? Registered 0 Return Receipt for Merchandise
? Insured Mail ? C.O.D.
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KEITH R. MILLER,
Plaintiff
V.
BERTHA MILLER,
Defendant
: IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
CIVIL ACTION - LAW
2000-5405 CIVIL TERM
IN DIVORCE
DEFENDANT'S MARRIAGE COUNSELING AFFIDAVIT
The defendant, being duly sworn according to law, deposes and says:
1. I have been advised of the availability of marriage counseling and understand that I
may request that the court require that my spouse and I participate in counseling.
2. I understand that the court maintains a list of marriage counselors in the Prothonotary's
Office, which list is available to me upon request.
3. Being so advised, I do not request that the court require that my spouse and I
participate in counseling prior to a divorce decree being handed down.
I verify that the statements made in this affidavit are true and correct. I understand that
false statements herein made are subject to the penalties of 18 Pa. C.S. Section 4904 relating to
unworn falsification to authorities.
Date: January 8th , 2001 UAL' e- Y Y
BERTHA MILLER
SOCIAL SECURITY INFORMATION SHEET
PURSUANT TO 23 Pa.C.S.A. SECTION 4304.1 (a) (3) ALL DIVORCES MUST
INCLUDE THE PARTIES SOCIAL SECURITY NUMBER
PLEASE FILL IN THE APPROPRIATE INFORMATION AND RETURN TO THE
PROTHONOTARY'S OFFICE
DATE: January 9, 2001
DOCKET NUMBER: 2000-5405 Civil Term
PLAINTIFF/FXTVVID SS# 177-52-8777
NAME: Keith R. Miller
DEFENDANT/RESWIRMW SS # 197-40-6374
NAME: Bertha R. Miller
CHRISTA BRADLEY, F/K/A CHRISTA IN THE COURT OF COMMON PLEAS OF
SNYDER
PLAINTIFF CUMBERLAND COUNTY, PENNSYLVANIA
V.
SCOTT GREGORY SNYDER
DEFENDANT
• 00-5705 CIVIL ACTION LAW
. IN CUSTODY
ORDER OF COURT
AND NOW, Tuesday, February 24, 2004 , upon consideration of the attached Complaint,
it is hereby directed that parties and their respective counsel appear before Melissa P. Greevy, Esq. the conciliator,
at 301 Market Street, Lemoyne, PA 17043 on Tuesday, April 06, 2004 at 10:30 AM
for a Pre-Hearing Custody Conference. At such conference, an effort will be made to resolve the issues in dispute; or
if this cannot be accomplished, to define and narrow the issues to be heard by the court, and to enter into a temporary
order. All children age five or older may also be present at the conference. Failure to appear at the conference may
provide grounds for entry of a temporary or permanent order.
The court hereby directs the parties to furnish any and all existing Protection from Abuse orders,
Special Relief orders, and Custody orders to the conciliator 48 hours prior to scheduled hearing.
FOR THE, COURT,
By. /s/ Melissa P. Greevy, Esq
Custody Conciliator
The Court of Common Pleas of Cumberland County is required by law to comply with the
Americans with Disabilites Act of 1990. For information about accessible facilities and reasonable
accommodations available to disabled individuals having business before the court, please contact our office.
All arrangements must be made at least 72 hours prior to any hearing or business before the court. You must
attend the scheduled conference or hearing.
YOU SHOULD TAKE THIS PAPER TO YOUR ATTORNEY AT ONCE. IF YOU DO NOT
HAVE AN ATTORNEY 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
32 South Bedford Street
Carlisle, Pennsylvania 17013
Telephone (717) 249-3166
!v & Me.:a5li:uYtYkHb y;y?ti}uia}t'?._ ?ry}y?yy:iW.. _ .. '?YYiiu .•
OF THE
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CHRISTA BRADLEY, formerly : IN THE COURT OF COMMON PLEAS
known as, CHRISTA SNYDER, : CUMBERLAND COUNTY, PENNSYLVANIA
V. : NO. 00-5705 CIVIL TERM
SCOTT GREGORY SNYDER, CIVIL ACTION -LAW
Defendant/Petitioner : IN CUSTODY
ORDER OF COURT
AND NOW, upon consideration of the attached Petition, it is hereby directed that the
parties and their respective counsel appear before,
, Esquire, the Conciliator, on the _ day of 2004, at
_.M., at the 4th Floor, Cumberland County Courthouse, Carlisle, Pennsylvania, for a
Pre-Hearing Custody Conference. At such Conference, an effort will be made to resolve the issues
in dispute; or if this cannot be accomplished, to define and narrow the issues to be heard by the
Court, and to enter into a Temporary Order. All children age five or older may also be present at
the Conference if requested by the Conciliator. Failure to appear at the Conference may provide
grounds for the entry of a temporary or permanent Order. Notification to the Defendant by the
Prothonotary's Office is waived.
For the Court,
Date of Order:
By
Custody Conciliator
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 Association
32 South Bedford Street
Carlisle, Pennsylvania 17013
Phone: (717) 249-3166
CHRISTA BRADLEY, formerly : IN THE COURT OF COMMON PLEAS
known as, CHRISTA SNYDER, : CUMBERLAND COUNTY, PENNSYLVANIA
Plaintiff/Respondent
V. : NO. 00-5705 CIVIL TERM
SCOTT GREGORY SNYDER, CIVIL ACTION -LAW
Defendant/Petitioner : IN CUSTODY
PETITION TO MODIFY CUSTODY
AND COMES NOW, the Petitioner, Scott Gregory Snyder, by and through his attorneys,
James, Smith, Dietterick & Connelly, LLP by John J. Connelly, Jr., Esquire, and files the following
Petition to Modify Custody and in support thereof, respectfully represents as follows:
1. The Petitioner is Scott Gregory Snyder, Defendant in the above-captioned action.
2. The Respondent is Christa Bradley, formerly known as Christa Snyder, Plaintiff in
the above-captioned action..
The parties are the parents of one minor child: Jason David Snyder, born November
11, 1999.
4. Pursuant to the October 9, 2000 Order of Court, the parties shared legal custody of
their minor child with Respondent having primary physical custody subject to the partial custody
rights of the Petitioner. Said Order is attached hereto and marked Exhibit "A".
5. Consistent with his shared custody rights, the Petitioner signed a consent in
February of 2002 for the minor child to attend play therapy with Cynthia Sniscak at Beech Street
Enhancement and Play.
6. Due to the constant difficulties incurred by the Petitioner in exercising his partial
custody rights to his son, the Respondent made the decision to discontinue his access to the child in
February of 2002.
7. Subsequent to his discontinuance of his partial custody rights, the Defendant
determined that the Respondent had begun, in August of 2001, taking the child to the Children's
Resource Center and alleging that the child had been abused by the Petitioner.
8. In October of 2002, the Petitioner learned that an allegation of sexual abuse had
been alleged against him and that Cumberland County Social Services for Children and Youth were
investigating the matter.
9. In December of 2002, the Agency filed an indicated report from which your
Petitioner appealed to the Department of Public Welfare, Bureau of Hearings and Appeals.
10. Based on a Petition filed by the Respondent requesting an adjustment in custody,
the Petitioner entered into an agreed Stipulation granting the Respondent primary legal and physical
custody on June 9, 2003, a copy of which is attached hereto and marked Exhibit "B"..
11. During the course of the investigation by Cumberland County Social Services for
Children and Youth, they had the opportunity to question the child's play therapist, Cynthia
Sniscak. As part of the Petitioner's preparation to defend himself before the Bureau of Hearings
and Appeals Administrative Law Judge, the Petitioner subpoenaed all of the records of Cynthia
Sniscak relating to the minor child to be presented at the hearing before the Administrative Law
Judge on February 4, 2004.
12, Ms. Sniscak appeared at the hearing without her records and refused to release them
because the Petitioner no longer had shared legal custody. Ms. Sniscak did acknowledge that
should the court order the production of the records or should the court return the parties to a shared
legal custody status, she would release the records to the Petitioner.
13. The Petitioner believes and therefore avers that the parties should return to the
shared legal custody order thereby permitting him access to the child's therapy records with Cynthia
Sniscak. In the alternative, your Petitioner requests that the court enter an order directing Ms.
Sniscak to produce the records to counsel for the Petitioner in order to prepare for the next
scheduled hearings in this matter on April 7`h and 8`t', 2004.
WHEREFORE, your Petitioner, Scott Gregory Snyder, prays that Your Honorable Court
order the parties to return to the shared legal custody arrangement existing in the Order of October
9, 2000.
Respectfully submitted,
JAMES, SMITH, DIETTERICK & CONNELLY LLP
Date: 0 By:
jo 'nnel , Jr., Esquire
e r tioner
Post Office Box 650
Hershey, PA 17033
(717) 533-3280
PA I.D. No. 15615
VERIFICATION
John J. Connelly, Jr., Esquire, represents that he is the attorney for the Petitioner, Scott
Gregory Snyder, in this case and is familiar with the facts concerning the parties, and verifies that
the statements made in the foregoing Petition to Modify Custody are true and correct. He
understands that false statements herein are made subject to the penalties of 18 Pa.C.S. Section
4904 relating to unworn falsification to authorities.
Date: 4 -1p -6 ry
` , OCT ,0 3 2000
CHRISTA BRADLEY SNYDER,
Plaintiff
M
SCOTT GREGORY SNYDER,
Defendant
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
: NO. 00-5705
CIVIL ACTION - LAW
CUSTODY
ORDER OF COURT
AND NOW, this day of 2000, upon consideration
of the attached Custody Conciliation Summary Report, it is ordered and directed as follows:
1. The parties, Christa Bradley Snyder and Scott Gregory Snyder, shall share legal
custody of the minor Child, Jason Snyder, born November 11, 1999. Each parent shall have
an equal right, to be exercised jointly with the other parent, to make all major non-emergency
decisions affecting the Child's general well-being including, but not limited to, all decisions
regarding his health, education and religion. Pursuant to the terms of this paragraph, each
parent shall be entitled to all records and information pertaining to the Child including, but not
limited to, school and medical records and information. To the extent one parent has
possession of any such records or information, that parent shall be required to share the
same, or copies thereof, with the other parent within such reasonable time as to make the
records and information of reasonable use to the other parent.
2. Physical Custody. Mother shall have primary physical custody of the minor Child
subject to Father's period of partial physical custody which shall be arranged as follows:
A. To commence on'September 22, 2000, Father shall have custody on
alternating Fridays from 3:30 PM until 7:15 AM Saturday morning.
B. To commence on September 30, 2000, Father shall have custody on
alternating Saturdays from 9:00 AM until Sunday at 4:00 PM.
NO. 00-5705
C. Father shall have the option of exercising one evening visit per week from
3:30 PM until 7:00 PM upon a 48-hour notice to Mother.
D. Father shall have one week of summer vacation subject to a 30-day
notice to the Mother
3. The parties shall share transportation in that the party receiving custody shall
provide transportation.
4, Holidays.
A. The following holidays shall be shared by mutual agreement of the
parties: New Year's Day, Easter, Memorial Day, Independence Day, Labor Day
and Thanksgiving.
B. Christmas shall be divided into two segments, Segment A and Segment
B. Segment A shall commence from December 24th at Noon and continue until
December 25th at Noon. Segment B shall commence from December 25th at
Noon and continue until December 26th at Noon. In even-numbered years,
Mother shall have Segment A and Father shall have Segment B. In odd-
numbered years, Father shall have Segment A and Mother shall have Segment
B.
5. In the event that Father is unable to exercise any of his periods of partial custody he
shall notify Mother prior to his change in plans.
6. This Order is temporary in nature and may be modified by the mutual consent of the
parties. In the event that the parties cannot agree, either party may seek modification of the
Order upon proper petition to the Court whereafter the matter shall be scheduled for a Custody
Conciliation Conference.
BY THE COURT,
Dist: Johnna Deily, Esquire, 26 W. High Street, Carlisle. PA 17013
John J. Connelly, Jr., Esquire, 134 Sipe Avenue, Hummelstown, PA 17036
TRUE COPY FROM RECORD
In Testimony %-h-.reof, I here c-;o set my hand
and t seal of $al Co?urt at Carlisle, Pa.
Thi .......I..I,..... ay
, V .......I..0....... rac
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CHRISTA BRADLEY SNYDER,
Plaintiff
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
vs.
SCOTT GREGORY SNYDER,
Defendant
NO, 00-5705
CIVIL ACTION - LAW
CUSTODY
CUSTODY CONCILIATION SUMMARY REPORT
IN ACCORDANCE WITH CUMBERLAND COUNTY RULE OF CIVIL PROCEDURE
1915.3-8, the undersigned Custody Conciliator submits the following report:
1. The pertinent information concerning the Child who is the subject of this litigation is
as follows:
NAME DATE OF BIRTH CURRENTLY IN CUSTODY OF
Jason Snyder November 11, 1999 Mother
2. A Conciliation Conference was held on September 18, 2000, with the following
individuals in attendance: The Mother, Christa Bradley Snyder, and her counsel, Johnna J.
Deily, Esquire; the Father, Scott Gregory Snyder, did not attend. Father's counsel, John
Connelly, Esquire, did not attend but participated by telephone.
3. The Order attached represents the agreements which the counsel for the parties
have been negotiating in correspondence prior to the conference date. In the event that
Father objects to the Order as recommended he may petition for modification of the Order and
attend a Custody Conciliation Conference as has been prg_viously directed.
Date
M#Ils?a Peel Greevy, Esquire
Custody Conciliator
JUN 0 5 2003 V
CHRISTA BRADLEY SNYDER, : IN THE COURT OF COMMON PLEAS
Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA
v. NO. 00-5705 CIVIL, TERM
SCOTT GREGORY SNYDER, =1 ACTION LAW
Defendant IN CUSTODY
ORDER OF COURT
QIL
AND NOW, this
day of 2003, based upon the attached
Stipulation of the parties, Christa. Bradley Snyder, Plaintiff/Mother, and Scott Gregory Snyder,
Defendant/Father, parents of Jason David Snyder, and stipulating as per agreement, primary legal
and physical custody of the minor child, Jason David Snyder, bom April 11, 1999, is hereby
awarded to Christa Bradley Snyder, Plaintiff/Mother. Any visitation/custody rights given to the
Defendant/Father, Scott Gregory Snyder, must be specifically set forth by a. future Order of this
Court.
In '6RUE' Copy FROM RECORD
aw dh. sea of Testimony whereof I here unto set my head
( said t Carlisle, Pa,
BY THE COURT:
CHRISTA BRADLEY SNYDER, Ill THE COURT OF COMMON PLEAS
Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA
V. : NO. 00-5705' CIVIL, TERM
?J
µy ^€7
SCOTT GREGORY SNYDER CIVIL ACTION - LAW
Defendant IN CUSTODY r r , _ i r7;
U3 r w.
i
4
z'
CUSTODY STIPULATION
WHEREAS, Chnsta Bradley Snyder, Plaintiff/Mother, and Scott Gregory Snyder,
Defmdant'Father, are the parents of Jason David Snyder, born April 11, 1999; and
WHEREAS, a custody conciliation on this matter was scheduled for May 12, 2003 at 11:00
a.m. before Melissa P. Greevy, Esquire; and
V ^`HEREAS, the parties wisb to enter a Stipulation to resolve the pending action.
WHEREAS, it is the desire of the parties to enter into the following Custody Stipulation.
NOW THEREFORE, the parties mutually agree as follows:
I. The Plaintiff is Cbrista Bradley Snyder, an adult individual, residing at 131
McAllister Church Road, Carlisle, Cumberland County, Pernsyl=-=aria.
2. The Defendant is Scott Gregory Snyder, an adult individual, residing at 51; 8`"
Street, New Cumberland, Pennsylvania.
3. The parties are the natural parents of Jason David Snyder, date of birth April 11,
1999.
4. The parties are now sugject to an Order of Court dated October 9, 2000, which is
attached hereto and marked E:dvbit "A", whereby the Plaintiff has primary physical custody of the
minor child subject to periods of partial physical custody of the Defendant. The parties are also
subject to a subsequent Order dated March 29, 2002 attached hereto and marked Exhibit "B".
5. The Defendant has not been exercising any physical custody or contact with Jason
David Snyder.
6. It is agreed to by both parties that primary legal and physical custody of Jason
David Snyder is awarded to the Plaintiff/Mother, Christa Bradley Snyder. Any visitation/custody
rights given to Scott Gregory Snyder, Defendant/Father, must be specifically set forth in a future
Order of this Court.
7. The Plaintiff and Defendant respectfully request Your Honorable Court to enter an
Order as written and attached to this Stipulation.
WHEREFORE, the parties hereto set forth their signatures intending to be legally bound.
WITNESSES:
n
I ess
Witness -
;
Christa Bradley Snyder 1
v' pro -""-? "i,, ??^'?•--."
Scott Gregory Snyder
CHRISTA BRADLEY, formerly
known as, CHRISTA SNYDER,
V.
SCOTT GREGORY SNYDER,
Defendant/Petitioner
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
NO. 00-5705 CIVIL TERM
CIVIL ACTION - LAW
IN CUSTODY
CERTIFICATE OF SERVICE
I, John J. Connelly, Jr., Esquire, of James, Smith, Dietterick & Connelly, LLP attorney for
the Petitioner, Scott Gregory Snyder, hereby certify that I have served a copy of the foregoing
Petition to Modify Custody on the following on the date and in the manner indicated below:
U.S MAIL, FIRST CLASS, PRE-PAID
Herbert Corky Goldstein, Esquire
204 State Street
P.O. Box 10363
Harrisburg, PA 17105-0363
DATE: '- i -/ p "t/ 4-
JAMES, SMITH, DIETTERICK
By:
, Jr.,
ost O p de B 650
ers ey, PA 17033
(717) 533-3280
PA I.D. No. 15615
Y LLP
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IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY,
PENNSYLVANIA
j h ny ll t .
Plaintiff
Vs File No. C1Q0?? ' c5 ?46 0
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 G u Lsh u ) / , and gives this
written notice avowing his / her intention pursuant to the provisions of 54 P.S. 704.
Date: U 9 41 l' t0
Signature
Signature of name being resumed
COMMONWEALTH OF EENNYLVANIA )
COUNTY OF Cumbe
On the _6 day of -M O.U , 2005, 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. n
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Notary Pub is
NOTARIAL SEAL
PROTHONOTARY, NOTARY PUBLIC
CARLISLE CUMBERLAND COUNTY COURTHOUSE
MY COMMISSION EXPIRES JANUARY 4, 2010
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