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010170843192 FG
JUDGEMENT NOTE
Mechaniesbur~ , Pennsylvania,10-30-06 , $3,136.05
FOR VALUE RECEIVED, Uwe promise to pay to the order of Erie Insurance Group
the sum of Three thousand one hundred thirty-six and OS/100 said sum to be payable
said sum to be as follows: One hundred dollars, ($100.00 on the 1St day of November,
2006 and One hundred dollars, ($100.00) on the 1St day of every month thereafter
until the entire amount is paid in full.
Uwe hereby authorize and empower any attorney of any Court of Record of Pennsylvania
or elsewhere, to appear for and confess Judgment against me for the sum due and payable
hereon, pursuant to PA. R.C.P. 2951 (a) (1) with or without declaration, with costs of
suit, interest at the rate of 6% per annum, an attorney's fee, release of errors, and without
stay of execution; and Uwe also waive the right of inquisition on any real estate that may
be levied upon to collect this note; and Uwe do hereby voluntarily condemn the same and
authorize the Prothonotary to enter said voluntary condemnation upon any Fieri Facias
that maybe issued to collect said Judgment; and Uwe further agree that said estate may
be sold on a Fieri Facias, and Uwe do hereby waive and release all relief from any and all
appraisement, stay of execution, exemption or bankruptcy laws of this or any other state
now in force or hereafter to be passed.
~- (L.S.)
A i atu Sesay
/ (L.S.)
This note is given executed without duress or coercion and with full and complete
understanding that upon failure to make payment as agreed, that my operating privileges
may be suspon+.'ed.
Further, I do hereby acknowledge that the damage incurred in the accident of
December 10, 2005, for which this note is given resulted from my negligence and fault,
and I do hereby acknowledge and waive my right to any hearing or trial on that issue.
DRIVER DATE OF BIRTH X
DRIVER OPERATOR NO. X
OWNER DATE OF BIRTH X
OWNER OPERATOR NO. X
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010170843192 FG
DISCLOSURE FOR CONFESSION OF JUDGMENT
UWe, ~~vl o~-tit ~~n executing this 30th day of
October , 2006 , a Judgment Note for Three thousand one hundred thirty-
six dollars and 05/100 ($3 136.05 DOLLARS obligating me to repay that amount.
Initials: X
A.S.
Initials:
It has been explained to me by representative of the Erie Insurance Group that the Note
contains wording that may permit them or their attorneys to enter Judgment against me at
the Courthouse, whether or not said Note is in default, without notice to me and without
offering me an opportunity to defend against the Entry of Judgment, and that the
Judgment maybe collected by any legal means.
Initials: X_~'!~
A.S.
Initials:
In executing the Note, UWe am knowingly, understandingly, and voluntarily waiving any
rights to resist the Entry of Judgment against me at the Courthouse, and am consenting to
the Confession of Judgment.
Initials: X
.S.
Initials:
010170843192 FG
I certify that my annual income (exceeds/is less than) TEN THOUSAND AND 00/100
DOLLARS, that the blanks in this disclosure were filled in when I initiated and signed it,
and that I received a copy at the time of signing.
X
~~ /~ Alimatu Sesay
Date: X ~/`
ACKNOWLEDGMENT
Commonwealth of Pennsylvania )
County of ~~,~,v/l. ~' )
Before me, the undersigned Notary, personally appeared ?~ ~~ 11'!~-}-~/ ~ Q~SF`~
whose initials appear above, and who acknowledges under
oath that they executed the above Disclosure for Confession of Judgment together with
the Confession of Judgment Note referred to in the First Paragraph of the Disclosure on
this date.
(SEAL}
Notary Pub is
My commission expires on the ~ ~ day of ;~_,20~.
~MMONW~~~ ~~~3~VANIq
Low~T~~ Fes~+~,~' N,_o~ta~~ry~~1c
Mem~rCp 1rf1l9gi~~eS_„r8.~ Q
ennsyivanla qs
sociatlon of Notaries
010170843192 FG
AFFIDAVIT TO ACCOMPANY JUDGMENT NOTE
Being duly sworn according to law, the undersigned jointly and severally depose and say
that:
1. UWe are over twenty-one years of age, not within the military service of the
United States and its allies nor otherwise within the civil relief provision of
the Soldiers and Sailors Civil Relief Act of 1947 as amended.
2. UWe have delivered to Erie Insurance a Judgment Note containing a
confession of judgment to secure certain payment obligations.
3. UWe understand that a confession of judgment allows for the entry of a
judgment by confession against them and that said judgment encumbers all
real estate that they own.
4. The note is not related to a consumer credit transaction.
IN WITNESS WHEREOF and intending to induce Erie Insurance to complete the
transaction as provided, he undersigned have affixed their hands and seals on this
day of l~P,a-~. , 20~.
X d (SEAL)
Ali atu Sesay
sworn to and subscribed before me
this ~d _day of ~{J , &t _ ,20~.
(SEAL)
i ~%~~~
Notarlet seal
gtr~opFter J. FMtlny, Notary PubNc
t~awer ANen Twp., Curnberiar-d Colydy
My Ccxrrnisefort E>~ires Juste 18, 2010
Member, Pennsylvania Association of Notaries
Public
010170843192 FG
CERTIFICATE OF RESIDENCE
The parties to the transaction are X
N
Ad ess
x s~ f/~1~~~~ D~}
Address
Address
I certify that these are the last known addresses of the parties to this matter.
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By:
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Richard Kellinger
c/o Erie Insurance Group
Plaintiff
vs
Alimatu Sesay
Defendant
To: Alimatu Sesay, Defendant (s):
} In the Court of Common Pleas
} Cumberland County
} Pennsylvania
}
}
}
}
} Docket No.
} Civil Action
}
You are hereby notified that on ~,~.~ a (,/ , 2007, the following (Order)
(Decree) (Judgment) has been entered against you in the above captioned case.
Date: 4 ~DD7
(Pro onot
Alimatu Sesay
459 Meadow Drive
Camp Hill, PA 17011
Erie
/~
~~ Insurance
Kerry J. Ritchey, CPCU, AIC
Ass+stant Vice President & Claims Manager
Branch Office 4901 Louise Drive Rossmoyne Business Center P.O. Box 2013 Mechanicsburg, PA 17055-0710
717.795.8200 Toll Free 1.800.382.1304 Fax 717.795.2315 www.erieinsurance.com
June 27, 2007
Cumberland County Prothonotary
Cumberland County Courthouse
1 Courthouse Square
Carlisle, PA 17013
Erie Claim #
Our Insured:
Date of Loss:
Defendant:
No. and Term:
010170843192
Richard Kellinger
12-10-2005
Alimatu Sesay
#07-2368
Dear Sir or Madam:
I certify that the above-captioned Judgment is a result of a Motor Vehicle Accident.
Sincerely,
~. ~
Sandra Goodling
Subrogation Specialist
1-800-382-1304
SG:car
The ERIE Is Above All In Service®. We commit, care and serve. It's our true blue promise.
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