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COMMONWEALT" OF PENNSYLVANIA
COURT OF COMMON PLEAS
NOTICE OF APPEAL
FROM 0 I - J tj 5 3 [1; V i L
JUDICIAL DISTRICT
DISTRICT JUSTICE JUDGMENT
COMMON PLEAS No.
NOTICE OF APPEAL
No~ce is given that the appellant has 'filed in the above Court of Common Pleas an appeal from the judgment rendered by the District Justice on the
date a~ case mentioned below.
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IN THE CASE OF (Plaintiff)
t!/1A 114.// p~ /70/'3
I MAG D~t NO OR NAME '" nJ.
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O.AIM NO
vs.
SIGNATURE OF APPELlANT
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" appellant was AIMANT (see Pa. R.GP.JP. No.
1001 (6) in action before District Justice, he MUST
FILE A COMPLAINT within twenty (20) days after
filing his NOTICE of APPEAL.
CV 1\1
LT 19
This block will be signed ONLY when this nota~on is required under Po. R.c
10088.
This Notice of Appeal, when received by the District Justice, will operate as a
SUPERSEDEAS ta the judgment far possession in this case.
Signature of Prothonotary or Deputy
PRAECIPE TO ENTER RULE TO FILE COMPLAINT AND RULE TO FILE
(This section of form to be used ONLY when appellant was DEFENDANT (see Pa. R.C.P.J.P. No. 1001 (7) in action before District Justice.
IF NOT USED, detach from copy of notice of appeal to be served upon appellee).
PRAECIPE: To Prothonotary
(Common Pleas No.
Name of appeJJee(S)
) within twenty (20) days after service of rule or suffer entry of judgment of non pros.
, appellee(s), to file a complaint in this appeal
Enter rule upon
SignatUle of appeHant Of his attorney or agent
RULE: To
Name of appe!tee(s)
, appellee(s).
(1) You are no~fied that a rule is hereby entered upan you ta file a complaint in this appeal within twenty (20) days after the date of
service of this rule upon you by personal service or by certified or registered mail.
(2) If you do not file a complaint within this time, a JUDGMENT OF NON PROS WILL 8E ENTERED AGAINST YOU.
(3) The date of service of this rule if service was by mail is the date of mailing.
Date:
,19_.
Sig1a/u1e of Prothonotary or Deputy
N:JPC 312-84
COURT FILE TO BE FILED WITH PROTHONOTARY
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pnOOf OF SERVICE OF NOTICE OF APPEAL AND RULE TO FILE COMPLAINT
(This proof of servfce MUST BE FILED WITHIN TEN (10) DA YS AFTER filing the notice of appeal, Check applicable boxes)
CDUNlY OF
COMI'IIONWI:.MJfH OF PI~NNSYLV~,NIA
; $$
A,FIFIDAVIT:
swear or affirm that I served
" copy of the Notice of Appeal, Common Pleas No, , upon the District Justice designated therein on
(date of service) 0 by persunal service 0 by (certified) (registered) mail, sender's
receipt attached hereto, and upon lhe appellee, (name) , on
_____ , 19_ by personal service 0 by (certified) (registered) mail, sender's receipt attached hereto.
and further.thatl served the Rule to Filea Complaint accompanying the above Notice of Appeal upon the appellee(s) to whom
the Rule was addressed on __ , ~19_~ 0 by personal service 0 by (certified) (registered)
mail, sender's receipt attached hen~to,
SWORN (AFFiFIMED) AND SUBSCRiBED BEFOREI ME'
THIS ____,___ DAY OF _
,19_._
Signature of affiant
Signature of ()ffici8J before whom affide.!rit was marh,
Tit/a of officiw'
My commisslon e.<pires on
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~"COMMONWEAL1HOF PENNSYLVANIA' .,.
';i "COUNTY OF:' criMBZRLANIY, ~ ~ . ~
.Mag. Disl. No.:
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'OJ Narri~': 'Hon.
,~ ~ ~ '.~ES A.i':CLEMENT'
~,Add"'r(~'ll.o6 ~CARLISLEROAD
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" ~ES'A.CLEMENT,
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'~NOTI9E 9F.JUOGMENTITRANSCRIPT
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'.-P~I.NTIF.F:". '.."'.: <"-~, ',:':, '. .'. :NAME'indADDRESS: ',' "
~ 'MYERS,TINA~' '".~ .~~ .'~'
~ 6.o95TH,STREET
c/O JIM TREECE ~~ ~, ~' ~
,~~' CUMBERLAND, ,PA,17070~'
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" DEFENDANT: . . "'NAME~':IdADD1=lESS.
, '!SAWYER, LARRY ,~~~ ~ ~~ . '~
1543 .INVERNES~,DRIVE ~~
MEcE:ANICSBoRq;'PA :.1.7055
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Dat~Fileq, 12/05!q,O
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~~D': Amountof JUdgmElrit SlIbjectto .
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Levy is stayed for
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, ,~ AN~,PARTY HASTH,E RIGHT TO APPEAL WITHIN, 30~ DAYS AFTER T~E ENTRYOI' J}l~~~~:r-BY'f.I(!~~;;f'!~OTICE
'OF APPEALWITH THEPROTHONOT ARYICLERK OF THE COURT OF COMfII1QI'!PLEfAS;tIVji:-DIV1sI0fl., YQU':. '>
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I certifyt~adhisis a true and correctcopy dfth(irecord of theproceedingSC(?ritaini'iw;~if&,jiJdgif)~l1t?~'. '
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'My commission expires first Monday of January,
AOPC 315,-~9 '
20,.02
i SEAL' ~
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TINA MYERS,
PLAINTIFF
: IN THE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY, PENNSYLVANIA
V.
LARRY SAWYER,
DEFENDANT
: 01-1453 CIVIL TERM
ORDER OF COURT
AND NOW, this
\'-\
day of March, 2001, the motion of plaintiff,
Tina Myers, to proceed in forma pauperis, IS GRANTED.
,
Tina Myers, Pro se
1101 Claremont Road
Carlisle, PA 17013
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Mag. Dlst. No.:
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IN FORMA PAUPERIS20 ~~
AFFIDAVIT/PETITION
'COMMONWEALTH OF PENNSYLVANIA
COUNTY OF: CUMBERLAND
09-1-01
OJ Nar'ne: Hon.
-{t;\,.A ;V\l ~~S
CHARLES A. CLEMENT, JR.
Add,,,,, 1106 CARLISLE ROAD
CAMP HILL, PA
\
17011
VS.
DEFENDANT: NAME.and ADDRESS
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T",phoo" (717) 761-4940
~ L rc.nt( R-Lf s: ftvv( CI-
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Docket No.:
Date Flied:
':,.
STATEMENT OF THE PETITIONER
I hereby request that this Court permit me to proceed in forma pauperis (without payment of the filing fee). In
support of this I state the following:
~;. I am the plaintiff in the above matter and because of my financial condition am unable to pay the fee for
filing this action.
02. I am unable to obtain funds from anyone, including my family and associq.tes, to pay the costs of litigation.
03. I represent that the informatio~ below relating to my ability to pay the fees and costs is true and correct:
NAME AND ADDRESS PRESENT EMPLOYER'S NAME AND ADDRESS
SOCIAL SECURITY NUMBER:
d- 0 (.- c; 'd.- -, G 9 () ':<, SALARY OR WAGES PER MONTH,
TYPE OF WORK:
.0 I AM PRESENTL YUNEMPLOYED.
, THE DATE OF MY LAST EMPLOYMENT WAS: t!J/;
.;;.-S
/
:)-0
SALARY OR WAGES PER MONTH:
TYPE OF WORK:
OTHER INCOME RECEIVED WITHIN THE PAST TWELVE MONTHS:
BUSINESS OR PROFESStON:
INTEREST:
!
DIVIDENDS:
OTHER SELF.EMPLOYMENT:
PENSION AND ANNUITIES:
SUPPORT PAYMENTS:
SOCIAL SECURITY BENEFITS:
DISABILITY PAYMENTS:
WORKMAN'S COMPENSATION:
PUBLIC ASSISTANCE:
UNEMPLOYMENT COMPENSATION AND SUPPLEMENTAL BENEFITS:
OTHER:
Aope 622A-92
PAGE 1 OF 2
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~I\ Docket Number:
II
OTHER CONTRIBUTIONS TO HOUSEHOLD SUPPORT:
WIFE] HUSBAND NAME: Lt:
SPOUSE'SEMPLOYERU) C /vCfi
TYPE OF WORK:
MY WIFE HUSBAND) IS EMPLOYED:
:tt / }..Cl.9
',0
,
. CONTRIBUTIONS FROM CHILDREN:
CONTRIBUTIONS FROM PARENTS:
OTHER CONTRIBUTIONS:
CASH:
PROPERTY OWNED
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CHECKING ACCOUNT:
SAVINGS ACCOUNT: '*;,
CERTIFICATES OF DEPOSIT:
REAL ESTATE (INCLUDING HOME);
( '1:9
C f&.\J '-1
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C,*i/ A (re.,<
AMOUNTOWED:$ ;Y
OTHER
MOTOR VEHICLE: MAKE
COST
STOCKS;BONDS:
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DEBTS AND OBLIGATIONS
MORTGAGE:
RENT:
LOANS:
OTHER:
7C (~E5.
PERSONS DEPENDANT UPON ME FOR SUPPORT
o (WIFE) (HUSBAND) NAME:
(>J' CHILDREN, IF ANY:
NAMEJ ACt7 f!:, 'f' ~o-CE'
AGE, ~
NAME:
AGE:
NAME:
AGE:
NAME:
o OTHER PERSONS. NAME:
AGE:
NAME:
AGE:
RELATIONSHIP:
NAME: RELATIONSHIP:
!Er4. I understand that I have a continuing obligation to inform the Court of improvement in my financial circum-
jV'j' stances which would permit me to pay the costs incurred herein.
ipl.5. I verify that the statements made in this petition are true and correct. I understand that false statements
herein are made subject to penalties of 18 Pa. C.S. Sec. 4904, relating to unsworn falsification to authorities.
Date:
" 5tDO Si nature of Petitioner:
Action b the District Justice:
fJ--( S /0 U Date
,
SEAL
My commission expires first Monday of January, 2002.
AOPC 6228-93
PAG~20F2
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~_~MONWEALi'H OF PENMsYD.VANIA
- ~. .. COURT OF COMMON PLEA'S
NOTICE OF APPEAL
FROM 0 1- J'I.53C;.v / L
JUDICIAL DISTRICT
DISTRICT JUSTICE JUDGMENT
COM_NPLEASNo.
NOTICE OF APPEAL
Notice is. given that the apPellant has filed in the above Court of Common Pleas an appeal from the judgment rendered by the District Justice on the
date a~hecasementioned below.
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NAME OF APPE )'IT;
oaJJL
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'IS.
SIGNATURE OF APPELlANT
,.".\,,<>:,i~I~~' 1: '~,,'J k'",.;,.,!{1.f:)'PWlt ',m
Thls;I\I~It''';;mbe ~.9ned ONLY when this notOfion is required~nder Po. R.C. . No; If appel/ant was 'AIMANT (see Pa. R.GP.JP. No.
10PI\8; . ~ '
~'Xhis~ N<>fice of Appeal, when received by the District Justice, will operate as a 1001 (6) in action before District Justice, he MUST
$U1~e~~EDEAS to the judgment for possession in this case. FILE A COMPLAINT within twenty (20) days after
'" filing his NOTICE of APPEAL.
'~$jgnature of Prothonotary or. Deputy
~ iM
PlAE,(IPE TO ENTEk RULE TO FILECOMPLAIINTANQ RULE TO IFILE
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(This section of fom1 to be,t!sed ONlXwhen flPPel/ant was ~fJjENDANT (see Pa. R.C.P.J.P.' No. 1 001( n in action before ~ eistrict Justice.
IF NOTDSEe; detach'fOI1' copy. of noti<<'!i9fappeaf to be)serVed)upon '@Pel/ee).!
. .,' ,N,' I,
PRAEt.PI: To pro~ta[yi, ~
Enter rule upon
. appellee(s), to file a complaint in this appeal
(Common Pleas No.
Name of appellee( s)
) within twenty (20) days after service of rule or suffer entry of judgment of non pro~
Signature of appellant or his attomey or agent
RULE: To
, appellee(s).
Name of appeJ/f1e(s)
~ . . '. '.~ ~'~.. " ~ . ,r.J. ~ ~ ~~ ~ ~ .~. ~ . ~~~'. ~~~~ ~:L .'~ ~ ~.~.
(I j You ,,/I,nofified that a rule is herebY ehteied upOn yoof to file c:i &impJaini 'In this 'PWeOl J"ihin tWenty (20) ~"ysafier; lhedate 01'
service of this rule upon you by personal service or by certified or registered mail. "
~
(2) If you do not file a complaint within this fime. a JUDGMENT OF NON PROS WILL BE ENTERED AGAINST YOlt
(3) The date "I service "f this rule if service was by m"il is the date 01 mailing.
Date:
.19_.
SigIa/uIe 0/ _ or_
N:JPC 31;2-84
COURT FILE
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PI~jOOF OF SERVICE OF NOTICE OF APPEAL AND RULE TO FilE COMPLAINT
(This proaf of seevice MUST BE FILED WfTHIN TEN (10) DA YS AFTER filing the notice 01 appeal, Check applicable boxes)
COMIIIONWI:./lI.TH Of PfillNSYlIIANIA i
~ L l /
COllNn Of-,(JJ.o.J Y''' n ,.JQ______ ;..
Jl,FFIDA\rIT: I swear or affirm that I served
e copy 01 the Notice 0.1 Appeal, Common Pleas No. ())- ) q)) r~ILi/-, upon the District Justice designated therein on
(elate of Ben/Co.) 7' I?' 01 _,__ . 0 by personal service 'l$J by (certified) (registered) mall, sender's
leceipt attached hereto, and upon the appellee, (name) ___ , on
__..___ , 19_,_ by personal service 0 by (certified) (registered) mall. senders receipt attached hereto.
C] and further that I served ,he Rul€, to File a Complaint accompanying the above Notice of Appeal upon the appellee(s) to whom
the Rule was addressed on ~_. , 19_~ 0 by personal service 0 by (certified) (registered)
, mall, sender's receipt attached ben~to_
SW(JRN (AFFIRMED) AND SUBSGRI\jED BEFORE ME
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Helen D. Sneed, Notary Public
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TINA MYERS,
: IN THE COURT OF COMMON PLEAS
: CUMBERLAND COUNTY, PENNSYL VANIA
Plaintiff,
v.
: NO: 01-1453 CIVIL TERM
LARRY SAWYER
: CIVIL ACTION - LAW
Defendant.
PRAECIPE
TO THE PROTHONOTARY:
Please strike the above-captioned matter as Plaintiff has not filed a Complaint
pursuant to the Pennsylvania Rules of Civil Procedure.
Respectfully submitted,
Mancke, Wagner, Hershey & Tully
By
P. ard Wagner, Esquire
. #23103
2233 North Front Street
Harrisburg, P A 17110
(717) 234-7051
Attorneys for Defendant
Date: .!5 / 1M "I
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May 31, 2001, Appeal Stricken.
Curtis R. Long, Prothonotary
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