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HomeMy WebLinkAbout00-07692 .. ;[,1, 1""..........1,-,- , -.- iUii~' . ... IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA DEBORAH L, ZEPP, Plaintiff v. NO. tHJ - '7<:.902 ~ '[;p- JOHN C. ZEPP, III., Defendant CIVIL ACTION - LAW DIVORCE NOTICE YOU HAVE BEEN SUED IN COURT. If you wish to defend against the claims set forth in the following pages, you must take prompt action. You are warned that if you fail to do so, the case may proceed without you and a decree of divorce or annulment may be entered against you by the court. A judgment may also be entered against you for any other claim or relief requested in these papers by the Plaintiff. You may lose money or property or other rights important to you, including custody or visitation of your children. When the ground for divorce is indignities or irretrievable breakdown of the marriage, you may request marriage counseling. A list of marriage counselors is available in the Office of the Prothonotary at the Cumberland County Courthouse, Carlisle, Pennsylvania. IF YOU DO NOT FILE A CLAIM FOR ALIMONY, DIVISION OF PROPERTY, COUNSEL FEES OR EXPENSES BEFORE THE FINAL DECREE OF DIVORCE OR ANNULMENT IS GRANTED, YOU MAY LOSE THE RIGHT TO CLAIM ANY OF THEM. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. CUMBERLAND COUNTY BAR ASSOCIATION 2 LIBERTY AVENUE CARLISLE, PA 17013 (717) 249-3166 DIANE G, RADCLIFF 3448 TRlNDLE ROAD CAMP HILL, P A 17011 (717) 737-0100 ,--1,",>-,_, - 0,1.,--. _ 'I"".~j;..;" ",:, -- -;, '" ,". '.' -, _,_~ ."'".', ,- - 't: .' IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA DEBORAH L. ZEPP, Plaintiff v. NO. 1J7). J&tf.z ~ T___ CIVIL ACTION - LAW DIVORCE JOHN C. ZEPP, III., Defendant COMPLAINT AND NOW, thiS~ay of October, 2000, comes the Plaintiff, DEBORAH L. ZEPP, by her attorney, DIANE G. RADCLIFF, ESQUIRE, and files this Complaint in Divorce of which the following is a statement: COUNT I: DIVORCE 1. The Plaintiff is DEBORAH L. ZEPP, an adult individual residing at 121 State Street, York Springs, PA 17372. 2. The Defendant is JOHN C. ZEPP, III" an adult individual residing at P. O. Box 204, York Springs, PA J7372. 3. Plaintiff and/or Defendant have been bona fide residents of the Commonwealth for at least six (6) months previous to the filing of this Complaint, 4. Plaintiff and Defendant were married on June 8, 1974 at York Springs, Pennsylvania. 5. There have been no prior actions of divorce or annulment between the parties. 6. Plaintiff has been advised of the availability of counseling and the right to request that the Court require the parties to participate in counseling. DIANE G, RADCLIFF 3448 TRINDLE ROAD CAMP HILL, P A 170 II (717) 737.0100 - 2- ~> DIANE G, RADCLIFF 3448 TRlNDLE ROAD CAMP HILL, PA 17011 (7] 7) 737-0]00 ',~~ 7. The Defendant is not a member of the Armed Services of the United States or any of its Allies. 8. The Plaintiff avers that the grounds on which the action is based are: a. That the marriage is irretrievably broken; Or in the alternative, b, That the parties are now living separate and apart, and at the appropriate time, Plaintiff will submit an Affidavit alleging that the parties have lived separate and apart for at least two (2) years and that the marriage is irretrievably broken. Or in the alternative, c. That Defendant has offered such indignities to the person of the Plaintiff, the innocent and injured spouse, as to render her condition intolerable and life burdensome, and that this action is not collusive. , WHEREFORE, Plaintiff requests this Honorable Court to enter a decree in divorce, divorcing the Plaintiff and Defendant. COUNT II: EOUITABLE DISTRIBUTION 9. Paragraphs 1 through 8 are incorporated by reference hereto as fully as though the same were set forth at length. 10, Plaintiff and Defendant have acquired property and debts, both real and personal, during their marriage from June 8, 1974 until April 10, 1999, the date of separation, all of which are "marital property" or "marital debts". 11. Plaintiff and/or Defendant have acquired, prior to the - 3 - - - DIANE G, RADCLIFF 3448 TRlNDLE ROAD CAMP HILL, P A 17011 (717) 737-0100 " I .-u, .i.='. ~",~I , ii!iI,U~, marriage or subsequent thereto, "non-marital property" which has increased in value since the date of marriage and/or subsequent to its acquisition during the marriage, which increase in value is "marital property". 12. Plaintiff and Defendant have been unable to agree as to an equitable division of said property and debts as of the date of the filing of this Complaint. WHEREFORE, Plaintiff requests this Honorable Court to equitably divide all marital property and debts of the parties, COUNT III: ALIMONY PENDENTE LITE. ALIMONY 13. Paragraphs 1 through 12 are incorporated by reference hereto as fully as though the same were set forth at length. 14. Plaintiff lacks sufficient property to provide for her reasonable means and is unable to support herself through appropriate employment. 15. Plaintiff requires reasonable support to adequately maintain herself in accordance with the standard of living established during the marriage. WHEREFORE, Plaintiff requests this Honorable Court to enter an award of alimony pendente lite until final hearing and hereafter enter an award of alimony permanently thereafter. - 4- ~" ~ " - . DIANE G, RADCLIFF 3448 TRlNDLE ROAD CAMP HILL, PA 17011 (717) 737-0100 I. ,I'~d .....'~.,: COUNT IV: COUNSEL FEES 16. Paragraphs 1 through 15 are incorporated by reference hereto as fully as though the same were set forth at length. 17. Plaintiff has employed Diane G. Radcliff, Esquire, as counsel but is unable to pay the necessary and reasonable attorney's fees for said counsel. 18. The Plaintiff is in need of hiring various experts to appraise the parties' marital assets and does not have the funds to pay the necessary and reasonable fees. WHEREFORE, Plaintiff requests this Honorable Court to enter an award of interim counsel fees, costs and expenses and to order such additional sums hereafter as may be deemed necessary and appropriate and at final hearing to further award such additional counsel fees, costs and expenses as are deemed necessary and appropriate. - 5- , .'-~"" ~ . ~.. . DIANE G, RADCLIFF 3448 TRlNDLE ROAD CAMP HILL, PA 17011 (717) 737-0100 1!!tn'J: J3 VERIFICATION DEBORAH L. ZEPP verifies that the statements made in this Complaint are true and correct. DEBORAH L. ZEPP understands that false statements herein are made subject to the penalties of 18 Pa.C.S. Section 4904, relating to unsworn falsification to authorities. i') 1 /// P - 6 - ~;_-'~],i- -~I~~I "..i _.. DIANE G, RADCLIFF 3448 TRINDlE ROAD CAMP Hill, PA 17011 (717) 737-0100 c, :.!J-e l,",f~~; I i ~_k IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA DEBORAH L. ZEPP, Plaintiff v, NO. 00-7692 JOHN C. ZEPP, III., Defendant CIVIL ACTION - LAW DIVORCE CERTIFICATE OF SERVICE I hereby certify that a true and correct copy of the Divorce Complaint has been served upon the Defendant by Certified Mail, Restricted Delivery on the 3rd day of November, 2000. The return receipt for said mailing is attached hereto as Exhibit "AU and made a part hereof. CLIFF, ESQUIRE Road , P A 17011 Phone: (717) 737-0100 Fax: (717) 975-0695 Supreme Court ID # 32112 Attorney for Plaintiff a'- .,.' t~ ., .~ DIANE G, RADCLIFF 3448 TRINDlE ROAD CAMP Hill, PA 17011 (717) 737-0100 ,I ,Ii ~ I~ Camp'lete item~ 1:' 2; cind 3:" Aiso complete item -4 if Restricted Delivery is desired. . Print your name and address on the reverse so that we can return the card to you. . Attach this card to the back of the mail piece, or on the front if space permits. ..~;. o Agent o Addressee Dyes o No ~ \ ?f1c9-- ~. Type ," rtified Mail 0 Express Mail egistered 0 Return Receipt for Merchandise Insured Mail 0 C.d.D. 4. Restricted Delivery? (Extra Fee) - "" Yes 2, ~Ujr5"l1~iP~lfZXDbelloc:v 6:1: ); lJ>LI T1~ j PS Form 3811 , July 1999 Domestic Return Receipt !;-:- ~'" 102595-99-M-1789 . EXHIBIT "AU -2- - - l-i -~''Iil:i:.,: .; ... DEBORAH L. ZEPP, PlaintifflPetitioner IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA VS. CIVIL ACTION - DIVORCE JOHN C. ZEPP, III, DefendantlRespondent NO, 00-7692 CIVIL TERM IN DIVORCE DR# 30,186 Pacses# 229102800 ORDER OF COURT AND NOW, this 2nd day of November, 2000, upon consideration of the attached Petition for Alimony Pendente Lite and/or counsel fees, it is hereby directed that the parties and their respective counsel appear before RJ, Shaddav on December 7, 2000 a/9:00A.M. for a conference, at 13 N, Hanover St., Carlisle, PA 17013, after which the conference officer may recommend that an Order for Alimony Pendente Lite be entered, YOU are further ordered to bring to the conference: (I) a true copy of your most recent Federal Income Tax Return, including W-2's as filed (2) your pay stubs for the preceding six (6) months (3) the Income and Expense Statement attached to this order, completed as required by Rule 1910,11t!;J (4) verification of child care expenses (5) proof of medical coverage which you may have, or may have available to you IF you fail to appear for the conference or bring the required doctunents, the Court may issue a warrant for your arrest. BY THE COURT, George E, Hoffer, President Judge Mail copies on 11-2:00 to: --,1 /1 ;::J.J- I l /~""'< ~~J . ~A---,(-(__~<",\.....c ' }\ '7~"'" . y- - , R, J, Shadday: Conference Officer I! V ~./ YOU HAVE THE RIGHT TO A LAWYER, WHO MAY ATTEND THE CONFERENCE AND REPRESENT YOU. 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 MAY GET LEGAL HELP. < Petitioner Respondent Diane Radcliff, Esquire Date of Order: November 2, 2000 CUMBERLAND COUNTY BAR ASSOCIA nON 2 LIBERTY AVE, CARLISLE, PENNSYLVANIA 17013 (717)249-3166 --~~ .~-~'~ I" ~ .,l~ l _ ~" ~:" . ... YOUR HAVE THE RIGHT TO A LAWYER, WHO MAY ATTEND THE CONFERENCE AND REPRESENT YOU. 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 MAY GET LEGAL HELP. CUMBERLAND COUNTY BAR ASSOCIATION 2 LIBERTY AVENUE CARLISLE, PA 17013 (717) 249-3166 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. BY OR FOR THE COURT: J. - 2 - ~ - = "~~ J' I ." ~,J- -''; , -. IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA DEBORAH L. ZEPP, Plaintiff v. NO. (y) '1(.91- CU::J. T~ JOHN C, ZEPP, III., Defendant CIVIL ACTION - LAW DIVORCE RE: PETITION FOR ALIMONY PENDENTE LITE AND INTERIM COUNSEL FEES AND COSTS TO TH:':O:~L:~i:'HE~~y~:D 6UR& . 2000, comes the Petitioner, Deborah L. Zepp, who files the this Petition for Alimony Pendent Lite and Interim Counsel Fees and Costs and respectfully represents that: 1. The Petitioner, Deborah L. Zepp, lS an adult individual residing at 121 State Street, York Springs, PA 17372. 2. The Respondent, John C. Zepp, III, is an adult individual residing at P) .0. Box 204, York Springs, PA 17372. 3. The Petitioner and Respondent were married on-June 8, 1974, at York Springs and separated on April 10, 1999. 4, The Respondent has not sufficiently provided support for the Petitioner. 5. The Petitioner is not on a financial par with the Respondent in prosecuting and/or defending this Divorce action and is unable to support herself in accordance with the standard of living established during the marriage and to pay her anticipated reasonable attorney's fees and costs incurred or to be incurred in the within divorce action. 6. The within action is being instituted by the filing of a Divorce Complaint concurrently herewith by the Plaintiff. DIANE G, RADCl.IFF 3448 TRlNDLE ROAD CAMP HILL. PA 17011 (717)737-0100 - 3 - Ii., L I. .lI.IW~a.-,'" , 7. That Complaint and this Petition represents the Petitioner's claims for Alimony Pendente Lite, Interim Counsel Fees and Costs. 8. A background information sheet pertaining to these claims has or will be filed with The Domestic Relations Office as required by Local Rules of Court. 9. The amount asked by the Petitioner for Alimony Pendente Lite is the maximum amount provided for under the guidelines. 10. The amount of Interim Counsel Fees and Costs requested by the Petitioner is $2,000.00. WHEREFORE, Petitioner prays that the Court enter an Order: 1. Requiring the Respondent to pay the petitioner Alimony Pendente Lite in the maximum amount provided for by law under the state support guidelines; 2. Requiring the Respondent to provide medical support for the Petitioner; 3. Requiring the Respondent to pay a reasonable amount towards the Petitioner's Interim Counsel Fees and Costs. Respectfully submitted, DIANE G, RADCLIFF 3448 TRINDLE ROAD CAMP HILL, PA 17011 (717) 737.QlOO - 4 - ~; ~ . DiANE G, RADCLIFF 3448 TRINDLE ROAD CAMP HILL, PA 17011 (717) 737-0100 oil , '<."""'''~~j" VERIFICATION I verify that the statements made in this Petition for Alimony Pendent Lite and Interim Counsel Fees and Costs 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. - 5 - 4; ~'" .LI., I " ~" II ... DEBORAH L. ZEPP, Plaintiff vs. JOHN C. ZEPP, III, Defendant ORDER _L I I' ,""'~ _ ' r""" - "'L~,:;i IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW NO. 00-7692 CIVIL TERM IN DIVORCE AND NOW this Z ~; day of :J>u.-.VCr , ud" , upon the Motion of the Defendant and the Stipulation of both parties, we hereby transfer this matter to the Court of Common Pleas of Adams County, Pennsylvania, and order ,and decree as follows to implement such transfer: 1. The Prothonotary of Cumberland County shall transfer and deliver, by mail or otherwise, to the Prothonotary of Adams County all of the documents filed in this matter and a certified copy of the docket entries of this case to date, along with the original of this order, 2. The Prothonotary of Adams County shall assign a docket number to this matter and treat it, thereafter, as if the action had been initia:ted in Adams County. 3. Defendant will pay the Adams County Prothonotary's filing fee for the opening of the action there. Both parties are hereby directed to cooperate with the representatives of this court and the Court of Common Pleas of Adams County to implement this order. BY THE COURT, /11 II II II Distribution: Diane G. Radcliff, Esquire 3448 Trindle Road, Camp Hill, Pa 17011 Samuel L. Andes, Esquire 525 North 12th Street, Lemoyne, Pa 17043 J. ~C~ /J ,;) 7. /rlJ '-f"" - . ,-.. II '" i J ~~,-, ,,- I I[ II I I ,I I DEBORAH L, ZEPP, Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA vs, CIVIL ACTION - LAW NO. 00-7692 CIVIL TERM JOHN C. ZEPP, III, Defendant IN DIVORCE STIPULATION OF THE PARTIES AND NOW come the above-parties and their attorneys, and stipulate and agree that this action shall be transferred to the Court of Common Pleas of Adams County, Pennsylvania, and that the court shall enter an order in substantially the form as the proposed order attached hereto to implement such transfer. , ESQUIRE c~~-=,~ c~~-~ SA L L. ANDES, ESC1UIRE II ;;! m~._ ...~ ,x ,; ~Ih, ~ I " " 'I II " Ii 'i i ,I , " i Ii i' " Ii i; 'I I " i: i! " " " I II " Ii II I I I I , i , Ii ,[ I, I ~ DEBORAH L. ZEPP, Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA vs. CIVIL ACTION - LAW NO. 00-7692 CIVIL TERM JOHN C. ZEPP, III, Defendant IN DIVORCE MOTION FOR TRANSFER OF CASE AND NOW comes the above-named Defendant, John C. Zepp, by his attorney, Samuel L. Andes, and moves the court to transfer this case to the Court of Common Pleas of Adams County, based upon the following: 1. Both Plaintiff and Defendant reside in Adams County. 2. Neither of the parties reside in or have any real connection to Cumberland County. 3, Both parties have not consented to venue in Cumberland County. In fact, both parties have agreed that this matter shall be transferred to the Court of Common Pleas of Adams County, as evidenced by the Stipulation filed with this Motion. WHEREFORE. Defendant moves this Court to enter the attached order to transfer this matter to the Court of Common Pleas of Adams County. ~ Attorney for Defendant Supreme Court 10 # 17225 525 North 12th Street Lemoyne, PA 17043 (717) 761-5361 ~ .~ ~ ~'-, -" ' -L; H. . ~ ~-grt .. ~ COMMONWEALTH OF PENN5YL VANIA COUNTY OF .ClJrll!!lERLAND Ct.'bAl\.lS 55.: JOHN C, ZEPP, III, being duly sworn according to law, deposes and says that the facts set forth in the foregoing document are true and correct to the best of his knowledge, information, and belief. ~~ G6 N C. ZEPP, III Sworn to and subscribed before me this ~.l,b. day of \xQ~~ ,2000. ~:j)~1 ~ ! ~~ry Public NOTARfAL SEAL RICHARD E, SlARE, Notary Public Latimore Township, Adams County . miss'.on ExD;ros March 3, l!00I.l , , '..L " Court of Common Pleas Cumberland County Pennsylvania DEBORAH L. ZEPP plaintiff VS JOHN C. ZEPP Defendant Docke t No. 00-7692 Civil Civil Action Law ADAMS COUNTY COURT OF CCMMON PLEAS (V\Cl~e~ t ~ It -e) 'f PLEASE ACKNOWLEDGE RECEIPT OF THIS CASE BY SIGNING AND DATING THIS DOCUMENT. .- RECORD RECEIVED: DATE: <- , (signature & title) Please Mail back Attn: Becky - Prothonotary office One Courthouse Square Carlisle PA 17013 -.--- , -il _I, ~ . OFFICE OF PROTHONOTARY COURT HOUSE f) It", " G-, ~olc\;ff 3 y ~ g 17,(\0\ \~ 1< eo. 01 ~~--==--=--=~_=--=-= r.J~iI\Pl-\:(l..\... p~ 11()JJ__~_________ CARLISLE. PA,WnUo"V II 2ml V ( /\- ~-I 3=1 TO The County of Cumberland DR Od:om'" 'L-,-~:'~~~-; -------- -- --~----:f?_- -- VS ___n___ ,S;:;h rc c.. - ~-Pf~~-~- !<@t ---.------ ---- if--~-" ,- il I I I-=-l -------- 1___1 -.- ------- ---. ._._----~. !-----I _.---_._..__.---~-------------- f2~. ~~L.~~___ .____._ 1-- ! I 'I ~ wllA"d PA i : '~--"""----,-- , I , 1-- --...--....-...---- -I ! (' QtAn " 1 , _!'1'lS_ , , ! I I 50 II 1r 50 ! I !- I 1-- , :II ,/'1 I [ I~I ---- , , ------ U- tPoJ ,-- -- 1 I !~- - OMMON PLEAS COURT I I ; I - .--- I -- -_.---------- 0;" '7Co.:t..2_~t;; I Ter I'o....~ I oF'e"""",,,,,, PI~~- -- f;e. F;r ' ir~~f~_J--:- ,-- _1~~copiQs ~_L'1~_cr.?f,e I Po~A-~ --~~~-~=~ - 7 ';' -rIfe --[Xe.- MAKE CHECK PAYABL" TO PROTHONOTA "" G..~_ 1frJ a RY. C ---------~- --------- ,-, / pc4 -/ ) - 0 J - ..... J -. .;L>f ~j , ~ AUTHORITY TO PAY COURT APPOINTED COUNSEL " COURT o District Justice 0 Common Pleas 3. FOR ID,J.. C,P" APPELLATE) o Appellate 0 Other 4. AT ICITY/STATE) 6, IN THE CASE OF .;z ,Pf\/) vs ..;2..", CJ f) 9, PROCEEDI~GI!' IDescribe briefly) I , 7. CHARGE/OFFENSE (PURDON CITATION) 11. PERSON REPRESENTED 1 0 "Defendant-AdUlt 2 0 Detendam-Juvenile 3 0 Appellant 4 0 Appellee 5 0 H.abells Peti!ioner 6 0 Material Witness 7 0 Parolee Charged With VIolation 8 0 Probationer Charged Wilh Viola lion 9 0 Other: clJ/VtT) u /J14s,lo"-- , Q. PERSON REPRESENTED (Full Name) Appl Dale 7'. I";. CP / 16. NAME OF ATTORNEY/PAYEE AND MAILING ADDRESS ,/ ~tVcl NAME OF COMMON PLE1IS JUDGE ASSIGNED TO CASE Lindsay Dare Baird 37 South Hanover Street Carlisle. PA 17013-3307 17, TELEPHONE No, dV3 -\~3j. CLAIM FOR SERVICES OR EXPENSES 1S. SERVICE DATES HOURS ... 0: ::> o o ~ a. Arraignment and/or Plea b. Preliminary Heiuing c. Motions and Requests d. Bail Hearings 8. Sentence Hearings t. Trial g. Revocation Hearings h. Juvenile Hearings i. Appeals Court ~ Other ($peclfy on additlonalsheetS)j),u, Ma t:...H r J\a'jl d). "~SJ-1I11b>1LI ~~ O~....:: TOTAL HOURS::s s./. (J2- :,- S- ~PERHOUR '-1- 1- 20. a Interviews and conferences b. Obtaining and reviewing records c. legal research and brief writing d. Investigative and other work (Specify on additional sheets) J./'O~ "jo ..... 00: ...::> ::>0 00 TOTAL HOURS = .SV sS- ~PER HOUR AMT. PER ITEM 21. ITEMIZATION OF REIMBURSABLE EXPENSES Mile80e $,25 oar mile x 0: W :I: 5 +,' ,--"' "-,,",,,~i o tJ - Ii, '!h/5. \\ I "'-" L.vue;- N~ (,5542 5, B,\10GET _COD~ . , lJl- ...:> ~ / iU_ 0!.1) a, 0 PETTY OFFENSE o FELONY 0 MISDEMEANOR - 2, VO 12. CIVJI- DOCKET N;O~'0i 1"/.,tJ"Ims ('IM/iI/l (1)/- \"- 13, CRIMINAL DOCKET NO 1 4, APPEALS DOCKET NO, 18. SO/~S;U57;O~E~~ AMOUNTS CLAIMED Multiply rate per hour limes loral hours to obtain "In Court8 com- pensation. Enter total beiow. 1SA. TOTAL IN COURT COMPo = $ S ;?.j---: to Multiply rate per hour limes total hours. Enter total "Out of Court" compensation below. 20A. TOTAL OUT OF COURT COMPo =$ d'?-, S'6 21A. TOTAL ITEMIZED EXP. =$ 22, CERTIFICATION OF ATTORNEY/PAYEE f / 23, GRANO TOTAL CLAIMED Has compensation and/or relmbu'~ent for work In this case previously been applied for? 0 YES /)if NO == $ ..<// ,.2.. _ r~ If yes, were you paid? 0 YES. /J.....NO If yes. by whom were you pald1 Howmuch~ 24. DEDUCT. PRIOR PVNTS. Has the person repre~ented paid ~ny money to you. or to your kn~.~ edge anyone else, In co~n&Ctlon ~I~h the matter lor = $ which you were appOinted to provide representation? DYES.,)Q'" NO l 1f;t$S. g.l.~ detl)1lls _on additIOnal shee;.~ rlL- I swear or affirm the truth or correctness ~ l1...t2urr::.. C/./ ~ ~ 25. NET AMOUNT CLAIMED of the above statements S5gnalure of At10~yee Date = $ "/1 o? . -..iO ~B .oSI.: it/ )..4 I~ -Z- 27, ~M;- APZ./~' ~O Copy 1 - Mail to ~ urt Adml~istrator at completi6n of service 26 APPRQVl ~ I ' . Hm SlQnature of PAVMt;NI Judge "".