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IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY
.
STATE OF
PENNA.
CHAD I. UPDEGRAFF.
No. 00-7699
PLAINTIFF
.
CIVIL TERM
VERSUS
DANIELLE L. UPDEGRAFF.
.
DEFENDANT
.
.
DECREE IN
DIVORCE
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,}IJIJ/, IT IS ORDERED AND
.
AND NOW,
DECREED THAT CHAD I. UPDEGRAFF
, PLAINTIFF,
AN D DANIELLE L. UPDEGRAFF
, 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;
NONE PENDING
.
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PROTHONOTARY
By TH
J.
ATTEST:
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CHAD I . UPDEGRAFF,
Plaintiff
v.
: IN THE COURT OF COMMON PLEAS
: CUMBERLAND COUNTY, PENNSYLVANIA
: CIVIL ACTION - LAW
: NO. 00-7619 Civil Term
DANIELLE L. UPDEGRAFF,
Defendant
: 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 the Complaint: October, 2000, by certified mail,
return receipt requested and regular mail to Defendant, Acceptance of Service filed
November 17, 2000.
3. Date of execution of the Affidavit required by Section 330 1( c) of the Divorce
Code: by Plaintiff on May 14, 2001; by Defendant on May 14, 2001.
4.
Related economic claims pending: None.
5.
Plaintiff's Waiver of Notice in ~3301(c) Divorce was filed with the Prothonotary
on May 21,2001. Defendant's W 'ver of Notice in ~3301(c) Divorce was filed
with the Prothonotary on May 21, 001.
May 31, 2001
Luther E. Milspaw, Jr., Esqu r
130 State Street, P.O. Box 9 6
Harrisburg, PA 17108-0946
(717) 236-0781; FAX (717) 2360791
Email: Lmilsoawlalmblawfirm.com
Attorney for Plaintiff
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CHAD I . UPDEGRAFF,
Plaintiff
v.
: IN THE COURT OF COMMON PLEAS
: CUMBERLAND COUNTY, PENNSYL VANIA
: CIVIL ACTION - LAW
: NO. 00..7639 Civil Term
DANIELLE L. UPDEGRAFF,
Defendant
: IN DIVORCE
CERTIFICATE OF SERVICE
In accordance withPA.R.C.P. 402 and 412, I do hereby certify that on the 31tstday of
May, 2001, I served a true and correct copy of the within Praecipe to Transmit Record upon
DANIELLE L. UPDEGRAFF, Defendant, by placing same in the United States mail, postage pre-
paid and addressed as follows:
Arthur K. Dills, Esquire
Diane M. Rupich, Esquire
Dils & Rupich
1017 North Front Street
Harrisburg, P A 171 02
May 31,2001
BY:
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Elizabeth M. Gable, Paralegal
Milspaw & Beshore
130 State Street, P.O. Box 946
Harrisburg, P A 171 08-0946
(717)236-0781; FAX (717) 236-0791
Email: Lmilsoawlffimblawfirm.com
Attorneys for Plaintiff
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CHAD I. UPDEGRAFF,
Plaintiff
: IN THE COURT OF COMMON PLEAS
: CUMBERLAND COUNTY, PENNSYLVANIA
v.
: CIVIL ACTION - LAW
DANIELLE L. UPDEGRAFF,
Defendant
: NO. ~- 71..f'9 {1c>~(~
: IN DIVORCE
NOTICIA
LE BAN DEMANDADO A USTED EN LA CORTE. Si usted guiere defenderse de estas
demandas expuestas en las paginas siguientes, usted tiene wente (20) dias de plazo aI partir de la
fecha de la demanda y la notificacion. Usted debe presentar una apariencia escrita 0 en persona 0 por
abogado y archivar en la corte en forma escrita sus defensas 0 sus objeciones a las demandas en
contra de su persona. Sea avisado que si usted no se defiende, la sin previo aviso 0 notificacion y por
cualquier queja 0 a1ivio que es pedido en la peticion de demanda. Usted puede perder dinero 0 sus
propiedades 0 otros derechos importantes para usted.
LLEVEESTADEMANDAA UN ABODAGO IMMEDIATAMENTE. SINOTIENE
ABOGADO 0 SI NO TIENE EL DINERO SUFICIENTE DE PAGAR TAL SERVICIO,
VAYA EN PERSONA 0 LLAME POR TELEFONO A LA OFICINA CUYA DIRECCION
SE ENCUENTRA ESCRITA ABAJO PARA AVERIGUAR DONDE SE PUEDE
CONSEGUIR ASSISTENCIA LEGAL.
CUMBERLAND COUNTY LAWYER REFERRAL SERVICE
CUMBERLAND COUNTY BAR ASSOCIATION
2 LmERTY AVENUE
CARLISLE, PA 17013
(717) 249-3166
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CHAD I. UPDEGRAFF,
Plaintiff
v.
: IN THE COURT OF COMMON PLEAS
: CUMBERLAND COUNTY, PENNSYLVANIA
: CIVIL ACTION - LAW
: NO.
DANIELLE L. UPDEGRAFF,
Defendant
: IN DIVORCE
NOTICE TO DEFEND
YOU HAVE BEEN SUED IN COURT. If you wish to defend against the claims set forth
in the following pages, you must take action with in twenty (20) days after this Complaint and Notice
are served by entering a written appearance personally or by attorney and filing in writing with the
Court your defenses or objections to the claims set forth against yeu. 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 erproperty or other rights important to you.
YOU SHOULD TAKE THIS PAl'ER TO YOUR LAWYER AT ONCE. IF YOU DO
NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE
OFFICE SET FORm BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP:
CUMBERLAND COUNTY LAWYER REFERRAL SERVICE
CUMBERLAND COUNTY BAR ASSOCIATION
2 LmERTY AVENUE
CARLISLE, PA 17013
(717) 249-3166
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CHAD I. UPDEGRAFF,
Plaintiff
: IN THE COURT OF COMMON PLEAS
: CUMBERLAND COUNTY, PENNSYL VANIA
v.
: CIVIL ACTION - LAW
: NO. 0-0- 7d9 ~ 1LuJv-
DANIELLE L. UPDEGRAFF,
Defendant
: IN DIVORCE
COMPLAINT IN DIVORCE
1. Plaintiff is Chad I. UpdegraH: who currently resides at 116 East Locust Street,
,
Mechanicsburg, Cumberland County, Pennsylvania, 17055.
I
2. Defendant is Danielle L. Updegraff, whlil currently resides at 445 Hemlock Lane,
Etters, York County, Pennsylvania 17319.
3. Plaintiff has been a bona :fide resident of the Commonwealth of Pennsylvania for at
least six (6) months immediately previous to the:filing of this Complaint.
4. Plaintiff and Defendant were married on May 16, 1998, in Cumberland County,
Pennsylvania.
5. There have been no prior actions for divorce between the parties.
6. Plaintiff has been advised that counseling is available and that she may have the right to
request that the Court require the parties to participate in counseling.
7. Defendant is not a member of the armed forces of the United States or any of its allies.
COUNT I
COMPLAINT UNDER SECTION 3301 (c) OR
3301 (d) OF THE DIVORCE CODE - NO FAULT
8. The marriage is irretrievably broken.
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9. The Plaintiff and Defendant have lived separately and apart since September 27, 1999.
Wherefore, Plaintiff requests this Court to enter a Decree of Divorce dissolving the
marriage between the parties pursuant to 23 Pa.C.S.A ~J301(c) or 3301 (d).
Respectfully submitted,
Date: October 30, 2000
By:
Lu her E. Mi!spaw, Jr., Es uire
Attorney ID # 19226
130 State Street, P.O. Bo 946
Harrisburg, PA 17108-094
(717) 236.07Sl;FAX 717.236-0791
Attorneys for Plaintiff
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CHAD I . UPDEGRAFF,
Plaintiff
: IN THE COURT OF COMMON PLEAS
: CUMBERLAND COUNTY, PENNSYLVANIA
v.
: CIVIL ACTION - LAW
: NO.
DANIELLE L. UPDEGRAFF,
Defendant
: IN DIVORCE
VERIFICATION
I verify that the statements made in the facts set forth in the foregoing Complaint in
Divorce are true and correct to the best of my knowledge, information and belief. I understand
that false statements herein are made subject to the penalties of 18 P A.C.S. Section 4904, relating
to unsworn falsification to authorities.
Date: loll'?> ) 0 0
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CHAD I . UPDEGRAFF,
Plaintiff
: IN THE COURT OF COMMON PLEAS
: CUMBERLAND COUNTY, PENNSYLVANIA
v.
: CIVIL ACTION - LAW
: NO.
DANIELLE L. UPDEGRAFF,
Defendant
: IN DIVORCE
CERTIFICATE OF SERVICE
In accordance withPA.R.C.P. 402 and 412, I do hereby certify that on the 30th day of
October, 2000, I served a true and correct copy of the within Complaint for Divorce upon
DANIELLE L. UPDEGRAFF, Defendant, by placing same in the United States mail both
certified, restricted delivery and regular mail, postage pre-paid and addfessedas follows:
DANIELLE L. UPDEGRAFF
445 HEMLOCK LANE
ETTERS, PA 11319
Date: October 30, 2000
BY:
f~ YV1. J!A
~ .. Gable, Paralegal
Milspaw &. Beshore
tlO State Street, P.O. Box 946
Harrisburg, PA l'llOS-0946
(711)236-lil7S 1; FAX (717) 236-0791
Attorneys for Plaintiff
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CHAD I. UPDEGRAFF,
Plaintiff
: IN THE COURT OF COMMON PLEAS
: CUMBERLAND COUNTY, PENNSYLVANIA
v.
: CIVIL ACTION - LAW
: NO.
DANIELLE L. UPDEGRAFF,
Defendant
: IN DIVORCE
CERTIFICATE OF SERVICE
In accordance withPA.R.C.P. 402 and 412, I do hereby eertif}' that on the 30th day of
October, 2000, I served a true and correct copy of the within Complaint for Divorce upon
Daniene L. Updegraff by and through her attorney, James L. Walsh. Esquire, by placing same in
the United States regular mail postage pre-paid addressed as fonows:
JAMES L. WALSH, ESQUIRE
NICHOLAS & FOREMAN, P.C.
4409 NORTH FRONT STREET
HARRISBURG, PA 17110-1709
Date: October 30, 2000
BY:
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Elizab.et11 M. Gable , Paralegal
Milspaw & Beshore
130 State Street, P.O. Box 946
Harrisburg, PA 17108-0946
(717)236-0781; FAX (717) 236-0791
Attorneys for Plaintiff
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CHAD I . UPDEGRAFF,
Plaintiff
: IN THE COURT OF COMMON PLEAS
: CuMBERLAND COUNTY, PENNSYL VANIA
v.
: CIVIL ACTION - LAW
,
DANIELLE L. UPDEGRAFF,
Defendant
; NO. ()() - '7 to fs9 C-,t Vt! ,.elf J11.
: IN DIVORCE
ACCEPTANCE OF SERVICE
I, DANIELLE L. UPDEGRAFF accept service of the Complaint in Divorce which was
filed on October 30 ,2000 in Cumberland COlinty Court of Common Pleas.
Date: f 1-1-()()
VJ;?1;or.!a~JIj
. DANIEI.LE L. UP EG
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CHAD I. UPDEGRAFF,
Plaintiff
: IN THE COURT OF COMMON PLEAS
: CUMBERLAND COUNTY, PENNSYL VANIA
v.
: CIVIL ACTION - LAW
: NO. 00-7689 Civil Term
DANIELLE L. UPDEGRAFF,
Defendant
: IN DIVORCE
AFFIDAVIT OF CONSENT
1. A Complaint in Divorce under Section 3301(c) (formerly 201 (c)) of the Divorce
Code was filed on October 30, 2000, and service was accepted by Defendant on November 7,
2000. The Acceptance of Service was filed on November 21,2000.
2. The marriage of the Plaintiff and Defendant is irretrievably broken and ninety (90)
days have elapsed from the date of filing the Complaint and service thereof.
3. I consent to the entry ofa 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. ~4904 relating to unsworn
falsification to authorities.
Dated: May 14, 2001
C~.~D~tiff
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CHAD I . UPDEGRAFF,
Plaintiff
v.
: IN THE COURT OF COMMON PLEAS
: CUMBERLAND COUNTY, PENNSYLVANIA
: CIVIL ACTION - LAW
: NO. 00.- 7b<f1-GI/J(j/\~
DANIELLE L. UPDEGRAFF,
Defendant
: IN DIVORCE
WAIVER OF NOTICE OF INTENTION TO REOUEST ENTRY OF A
DIVORCE DECREE UNDER Ii 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! 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. ~ 4904 relating to unsworn
falsification to authorities.
Dated: May 14, 2001
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CHAD I . UPDEGRAFF,
Plaintiff
: IN THE COURT OF COMMON PLEAS
: CUMBERLAND COUNTY, PENNSYL VANIA
v.
: CIVIL ACTION - LAW
: NO. ~- 71.89 G<.)~[c,-~
: IN DIVORCE
DANIELLE L. UPDEGRAFF,
Defendant
AFFIDAVIT OF CONSENT
1. A Complaint in Divorce under Section 330l(c) (formerly 20 1 (c)) of the Divorce
Code was filed on October 30,2000, and service was accepted by Defendant on November 7,
2000. The Acceptance of Service was filed on November 21,2000.
2. The marriage of the Plaintiff and Defendant is irretrievably broken and ninety (90)
days have elapsed from the date of filing the Complaint and service thereof.
3. I consent to the entry ofa final decree in divorce after service of notice ofintel1tion
to request entry of the decree.
I verilY 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. ~4904 relating to unsworn
falsification to authorities.
Dated: May 14, 2001
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CHAO I. UPDEGRAFF,
Plaintiff
v.
: IN THE COURT OF COMMON PLEAS
: CtrMBERLAND COUNTY, PENNSYLV ANJA
: CIVIL ACTION - LAW
:
: NO. 00..7689 Civil Term
DANIELLE L UPDEGRAFF,
Defendant
: IN DIVORCE
W AlVER OF NOTICE OF INTENTION TO REQUEST ENTRY OF A
DIVORCE DECREE UNDER ~ 33011c) OF THE DIVORCE CODE
1. I consent to the entry ofa final deqree of divorce without notice.
2. I understand that I may lose rights concerning alimony, division of property, lawyer's
fees or expenses ifl do not claim them before a divorce is granted.
3. I understand that I wil1 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. S 4904 relating to unsworn
falsification to authorities.
Dated; May 14, 2001
______1
CHAD I. UPDEGRAFF,
Plaintiff
vs.
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY,
PENNSYL VANIA
NO. 00-7689 Civil Term
DANIELLE L. UPDEGRAFF,
Defendant
IN DIVORCE
PETITION FOR ALIMONY PENDENTE LITE
AND NOW, this /1 Day of November, 2000, comes Danielle L.
Updegraff, by her attorney, Arthur K. Dils, Esquire, and respectfully requests the
following:
1. Your Petitioner is Danielle L. Updegraff, the Defendant in the above captioned
matter, who is represented by Arthur K. Dils, Esquire, 1017 North Front Street,
Harrisburg, Pennsylvania 17102.
2. The Respondent is Chad I. Updegraff, the Plaintiff in the above captioned matter,
who is represented by Attorney Luther E. Milspaw, Jr, 130 State Street, Harrisburg,
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Pennsylvania 17108.
3. The Plaintiff has filed the above captioned divorce action against your Petitioner,
the Defendant, on October 30, 2000.
4. The Plaintiff left your Petitioner for another woman.
5. Your Petitioner suffers from depression and is on medication.
6. Your Petitioner receives minimal spousal support in the amount of $15.00 per
week from the Plaintiff.
7. Your Petitioner is in need of alimony pendente lite.
8. Your Petitioner cannot meet her needs and defend the above action.
.
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WHEREFORE, your Petitioner prays your Honorable Court to grant her
alimony pendente lite.
Respectfully submitted,
BY~
Arthur K. Dils, Esquire
1017 North Front Street
Harrisburg, Pa. 17102
(717) 232-9724
J.D. No. 07056
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I verify that the statements made i!ll~is Pe1;ition for APL
are true and correct. I understand Ihllllullie lilalemenlli herein arc made subject
to t1w penalties of 18 Pa. e.s. Section 4904 n:laling to unsworn falsitication to
~d1orities.
D~: November 7, 2000
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CERTIFICATE OF SERVICE
I, Arthur K. Dils, Esquire hereby certify that a true and correct copy of the
within Petition for Alimony Pendente Lite has been served upon the following
individual by depositing a copy of the same in the United States Mail, First Class
Mail, on the /7 day of November, 2000 to the following address:
Luther E. Milspaw, Jr., Esquire
130 State Street
P.O. Box 946
Harrisburg, Pa. 17108-0946
Respectfully submitted,
BY:
hur K. Dils, Esquire
1017 North Front Street
Harrisburg, P A 17102
(717) 232-9724
J.D. No. 07056
Date: November 1;7, 2000
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CHAD L UPDEGRAFF,
Plaintiff
vs.
DANIELLE L. UPDEGRAFF,
Defendant
TO THE PROTHONOTARY:
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IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY,
PENNSYLVANIA
NO. 00-7689 Civil Term
IN DIVORCE
PRAECIPE
Please withdraw the Petition for Alimony Pendente Lite filed on behalf of the
Defendant, Danielle L. Updegraff, in the above captioned divorce action.
Date: February 1,2001
BY:
~
Arthur K. Dils, Esquire
1017 N. Front Street
Harrisburg, Pa. 17102
(717) 232-9724
LD. No. 07056
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CERTIFICATE OF SERVICE
I, Arthur K. Dils, Esquire hereby certify that a true and correct copy of the
within Praecipe has been served upon the following individuals by depositing a copy
of the same in the United States Mail, First Class Mail, on the ;pe- day of
February,2001 to the following addresses:
Luther E. Milspaw, Jr., Esquire
130 State Street
P.O. Box 946
Harrisburg, P A. 17108-0946
BY:
Arthur K. Dils, Esquire
1017 North Front Street
Harrisburg, P A 17102
(717) 232-9724
LD. No. 07056
Date: February~OI
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M 105.157 REV. 8.80
COMMONWEALTII OF PENNSYLVANIA
DEPARTMENT OF HEALTII
VITAL RECORDS
00 -7(,39
I COUNTY - Cumberland
I
DIVORCE
RECORD OF
OR ANNULMENT
CHECK ONE II
IXI
I STATE FILE NUMBER
I
I STATE FILE DATE
I
1. NAME (First)
CHAD I. UPDEGRAFF
HUSBAND
(Middle)
(Last)
3. RESIDENCE
Street or RD.
City,Boro. Twp.
County
State
12. DATE (Month) (Vay) (Year)
I OF 02 26 1972
I BIRTII
14. PLACE (State or Foreign Country)
I OF PENNSYLVANIA
I BIRTII
17. USUAL OCCUPATION
I CUSTOMER SERVICE REPRESENTATIVE
I
860 DARTMOUTH ST., Co331. LOWER PAXTON TWP. DAUPHIN CO. PA
5. NUMBER 16. RACE
OF TIllS. I WHITE BLACK OTIlER (SpecifY)
MARRIAGE I IXI II I I
WIFE
8. MAlDEN NAME (First) (Middle) (Last)
19. DATE (!Jonth) (Vay)
I OF 08 30
I BIRTII
Ill. PLACE
I OF
MISSOURI I BIRTII
12. NUMBER 113. RACE I 14. OCCUPATION
OF TIllS I WHITE BLACK OTIlER (SpecifY) I CLERK
'lUDDUnU I IVI IT I I I
IS. PLACE OF (County) (State or Foreign Country) 116. DATE OF
TIllS I TIllS
MARRIAGE DAUPHIN COUNTY, PENNSYLVANIA I MARRIAGE
17A NUMBER OF ClllW117B. NUMBER OF DEPENDENT 118. PLAINTIFF 119. DECREE GRANTED TO
RENTIIlS I Cll1LDRENUNDERI8 I HUSBAND WIFE OTHER (SpecifY) IlillSBANDWIFEO'J'!!l1R(SpociJY)
MARRIAGE 0 I 0 I I I I I I I I IX I I I I I
20. NUMBEROF HUSBAND WIFE SPLIT CUSTODY OTHER(SpecifY) I 21. LEGAL GROUNDS FOR
ClllWRENTO I DlVORCEORANNULMENT
CUSTODY OF I I I I I I NONE I MARRIAGE IS lRRETRlEVABLY BROKEN
22. DATE OF DECREE (Month) (Day) (Year) 123. DATE REPORT SENT (!Jonth) (Vay) (Year)
I TO VITAL RECORDS
(Year)
1976
10. R.esidence
DAN1E1LE LOUISE JOHNSON
Street or RD. City,Boro or Twp.
County
State
(State or Foreign Country)
PENNSYLVANIA
(!Jonth)
05
(Vay)
16
(Year)
1998
24. SIGNATURE OF
TRANSCRIBING CLERK
I
t.
_i~'1
. '. - "" ..-- ,~""'-~,- .-~-- ~~;li~~J
CHAD I. UPDEGRAFF,
Plaintiff
: IN THE COURT OF COMMON PLEAS
: CUMBERLAND COUNTY, PENNSYLVANIA
v.
: CIVIL ACTION - LAW
: NO. 00-7689 Civil Term
DANIELLE L. UPDEGRAFF,
Defendant
: IN DIVORCE
SOCIAL SECURITY INFORMATION SHEET
Pursuant to 23 Pa.C.S.A. Section 4304.1(a)(3), listed below are the social
security numbers for the plaintiff and defendant in the above-captioned divorce
action.
DATE: May 31,2001
DOCKET NUMBER: NO. 00-7639 Civil Term
NAME: Chad I. Updegraff
PLAINTIFF/PETITIONER SS#: 192-68-7616
NAME: Danielle L. Updegraff
DEFENDANT/RESPONDENT SS#: 173-58-9414
AS OF ) d- - 1)- ~O{)(.
CASE# ~DOO - I fa ~Cf
HAS BEEN SCANNED.
ALL EARLIER
FILINGS TO THIS
CASE HAVE BEEN
MICROFILMED.
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY,
PENNSYLVANIA
ClJrJd r Ifmlmlf
Plaintiff
Vs
File No. m- 7; ?l
IN DIVORCE
[;a1J1f7!Ja I. ifif/e(QIf
efendant
NOTICE TO RESUME PRIOR SURNAME
Notice is hereby given that the Plaintiff I 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 ofa Final Decree in Divorce dated ;an' ~!lJ)J ,
hereby elects to resume the prior surname of l~h IJ.SO ^ , and gives thi~
written notice avowing his / her intention pursuant to the provisions of 54 P.S. 704.
Dare: /:1/1/ In/" , ])t1.1t1:u!t j! L~
/ Signature
COM:MONWEALTH OF PENNSYLVANIA )
COUNTYOF ~b(..,...JCl.~
On the J /..,.-L day of J)e..c..e.iJ:,~r , 200..k, 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 I 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.
liiVr;. vVi'" II .-~ l>.."h~~ ....:..~'-
In 11 whereof, I
1nd till
r
/s/ ~ I.. cY~
Prothonotary or Notary Public
c!I~.~ Gf~ &;)
NOTARIAl. SEAl.
PRCmtONoT~ NOTARY PUIUC
CAIULE CUMBERLAND COUN1Y COURTHousE
MY COMMISSIOtfOPlRQ.INIMRr 4.2010
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