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IN THE COURT OF COMMON PLEAS OFr c u m 6 e r l a n d COUNTY; PENNSYLVANIA
~ d.~i n I R~ z a ray ,PLAINTIFF
VS.
1~i11ian Irizarry ,DEFENDANT
C1VII. ACTION
NO. o> - y9i 9
`_ - ORDER
f
AND NOW, this ~ day of
before this court, and pursuant t Pa. R. Civ. P. 1920.62,
in Divorce without payment of court costs or fees.
20 O `, upon consideration of the Petition
petitioner is granted leave to file the Complaint
The Complaint shall be served as provided in Pa. R. Civ. P. 142; provided, however, that petitioner shall
attempt personal service by restricted mail, restricted delivery, return receipt requested, before requesting
the Sheriff to make service of the Complaint in this action without fee.
Petitioner may proceed in Fotma Pauperis until further Order of the Court.
date.
1920.62,
to deoo
of $
aze
of today's
wth the prothonotary withdn
By the Court,
/~r
~8-zl -o ,
Rg
IN THE COURT OF COMMON PLEAS OF C u m 6 P r l a n d COUNTY, PENNSYLVANIA
Edwin Irizarry ,PLAINTIFF
CIVIL. ACTION
VS.
Irizarry Lillian ,DEFENDANT
NO.
Rulc to Show Cause-Permissio® to Proceed in Forma Pauperis
AND NOW, this day of , 20 ,upon motion of petitioner,
the court hereby grants a Rule upon defendant, and any other interested parties, to
show cause why plaintiff should not be permitted to proceed in Forma Pauperis and
without posting bond in the above captioned divorce proceedings.
Petitianer shall be permitted to proceed in Forma Pauperis pending entry of a final
order on this petition by the Court; provided, however, that Petitianer shall attempt
personal service or service by registered mail, restricted delivery, return receipt
requested, before requesting the Sheriff to make service of the Complaint in this action
without fee.
Rule returnable, the day of 20~, at
Courtroom ,Pennsylvania.
By the Court,
o'clock, _.M., in
J.
IN THE COURT OF COMMON PLEAS OF Cumber 1 a n d COUNTY, PENNSYLVANIA
Edwin Irizarry ,PLAINTIFF
VS.
CIVIL ACTION
Lillian Irizarrv ,DEFENDANT NO. Q~- `f~~ ~l .CiV1
PETITION TO PROCEED IN FORMA PAUPERIS
TO THE HONORABLE, THE JUDGES OF THE SAID COURT:
Petitioner respectfully represents that:
1. Petitioner, E d Nr i n Irizarrv , is the plaintiff in the above-
captioned action or divorce.
2. Petitioner's social security number is: 5 8 3 ~- 0 8 -4 s 11 A
3. Petitioner's address is: The State Correctional Institution at Camp Hill,
P.O. Box 200, Camp Hill, PA 17001-0200.
4. Petitioner's income information is fully and accurately set forth on the
attached IN FORMA PAUPERIS STATEMENT.
5. In addition to the petitioner, the following are dependant on such income:
(a) Child(ren) of this marriage:
noel Irizarry ZACH
(b) OtherS:gd am Farnanrla~ Frl ~,
Petitioner and Respondent).
6. Respondent, Lillian Irizarr
captioned action for divorce.
Irizarry
t0
is the defendant in the above-
7. Respondent's social security number is: 095-s2-5364
8. Respondent's address is: 139 n pinest ynrk PA 1 74n4
9. Respondent's income and source are believed to be:
10. (If unemployed, state when and where respondent was last employed.)
1
11. A support complaint was filcd against respondent on or about the
day of , 20
(a) The Domestic Relations number is: 1~0 . ~z) ,~ ~'
(h) Petitioner receives support from respondent totaling per
week/month.
(c) Petitioner (has)(has not) assigned support rights to the Department of
Public Assistance.
12. After talking with an attorney, Petitioner is of the opinion that he has a
good and just-cause against the above named respondent on the grounds of
13. Petitioner is unable to pay any of the necessary costs, or giver security for
the fees, costs and expenses, necessary to prosecute said action without
substantially impairing his ability to provide the necessities of life for himself
and his child(ren).
14. WHEREFORE, Petitioner respectfully requests your Honorable Court to
enter an Order Granting Petitioner leave on file the Complaint in Divorce as
an indigent party and to proceed to termination thereof without the necessity
of paying an costs therefore.
Respectfully submitted,
4~ t~~A
Petitioner
2
IN THE COURT OF COMMON PLEAS OF Cumber 1 a n d COUNTY, PENNSYLVANIA
~dwin Irizarry ,PI.AINTITF
CIVIL ACTION
VS.
Lillian Irizarry ,DEFENDANT
NO.
IN FORMA PAUERIS STATEMENT
I, Edwin Irizarry ,states under penalties provided by 23 Pa. C.S.A. b106 relating to
unswom falsification to authorities that:
1. I am the plaintiff in the above action and because of my financial condition I am unable to pay the
court costs or fees to file the Complaint of Divorce.
2. My responses to the questions below relating to ability to pay the fees and cost are true and
correct.
(A) Are you presently employed? YES,
~ .25 ~ -~ 35.no Tale 20
(1) If the answer is "yes," state the arnoum of yow salary or wages per month, and give the
name and address of your employer. (List both gross and net salary) ~ 35 .o D ~ o ~ f h
~(S•i3ax ~.oo Caxna Will< ~a ~lloai-62op tassesme,ez ` sip. Mr.~"~re~nz&n
(2} )f the answer is "no," state the date of last employment and the amount of the salary and
wages per month which you received.
(B) Have you received within the past twelve months any money from and of the following
sowces?
(1) Business, profession or other form of self-employment? YES
(2) Rent paymems, interest or dividends? YES
(3) Pensions, annuities or life inswance payments? YES
(4) Gigs or inheritances? yEg
(3) Any other sowces? yES
If the answer to any of the above is "yes," describe each source of money and state the amount
received from each during the pass twelve months.
(C) Do own any cash, or do you have money in checking or savings accounts?
YES (Include any funds in prison accounts.)
If the answer is "yes," state the total value of the items owned.
(D) Do you own or have any interest in any real estate, stocks, bonds, notes, automobiles or other
valuable property (excluding ordinary household furnishings and clothing)? YES
If the answer is "yes," describe the property and state its approxunate value.
(E) List the persons who are dependent upon you for support, state your relationship to those
persons, and indicate how much you contribute toward their support.
3. I understand that a false statement or answer to any question in this verified statement will subject
me to the penalties provided by law.
yES Iundarstand
Executed on / ` ~ ~(~ Q
(Date)
2
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July 18, 2001
Edwin Irizarry
EG-0347
PO Box 200
Camp Hill, PA 17001-0200
Dear Mr. Irizarry:
I am returning your petition to proceed "in forma paueris [sic]." You
answered all the questions "YES" dealing with employment and/or assets.
If you made a mistake, do it over the correct way.
Yours truly,
George E. Hoffer
~/ v~JV
1
Mr. Edwin Irizarry
EG-0347
PO Box 200
Camp Hill, PA 17001-0200
Dear Mr. Irizarry:
We are in receipt of your complaint in divorce. It is being returned to you
because it should not be filed in the Judge's office. Please file it
appropriately.
Sincerely,
Sandra S. Gobrecht
Secretary
PYS510D Cumberland County Prothonotary's Office
Case Entries
2001-04919 IRIZARRY EDWIN (vs) IRIZARRY LILLIAN
Filed Date: 8/16/2001 Time: 9:02 Case Type: COMPLAINT - DIVORCE
Page 1 of 1
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8/16/Ol COMPLAINT - DIVORCE
-------------------------------------------------------------------
8/16/Ol PETITION TO PROCEED IN FORMA PAUPERIS
-------------------------------------------------------------------
8/16/O1 ORDER - DATED 8-15-01- PETITIONER IS GRANTED LEAVE TO FILE
THE COMPLAINT IN DIVORCE WITHOUT PAYMENT OF COURT COST AND FEES
SERVICE OF COMPLIANT BY MAIL BY PETITIONER - PRTITIONER MAY PROCEED
IN FORMA PAUPERIS UNTILL FURTHER ORDER OF COURT - BY THE COURT
GEORGE E HOFFER P J - COPIES MAILED 8-21-01
- - - - - - - - - - - - - - LAST ENTRY - - - - - - - - - - - - - -
F2=Done F10=Print F12=Cancel F17=Top F18=Bot
WIN IRIZARRY
Plaintiff
V.
LILLIAN IRIZARRY
Defendant
IN RE: DIVORCE COMPLAINT
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
CIVIL ACTION
NO. 01-4919 CIVIL TERM
ORDER OF COURT
AND NOW, April 30, 2002, pursuant to the letter request of the
plaintiff, the divorce complaint shall be marked SETTLED and DISCONTINUED
by the Prothonotary.
J.
win Irizarry
EG-0347
PO Box 256
Waymart, PA 18472-0256
i lian Irizarry
1114 CreagerAvenue
Interlachan, FL 32148
7 ~3a-oz ~ s
By the Court,
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