HomeMy WebLinkAbout07-63201.
V r
010170880726 BM
j~
JUDGEMENT NOTE ~ • D 7 - G 3~ o ~..c~Ll .-..
Mechanicsburg ,Pennsylvania, 1-25-2007 , $9,322.37
FOR VALUE RECEIVED, Uwe promise to pay to the order of Erie Insurance Group
the sum of Nine thousand three hundred twenty-two dollars and 37/100 said sum to
be payable said sum to be as follows: Two hundred dollars, ($200.00 on the 15th day
of February, 2007 and Two hundred dollars, ($200.00 on the 15th 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.
~~1~~~~ (L.S.)
Wanda Rothrock
(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
maybe suspended.
Further, I do hereby acknowledge that the damage incurred in the accident of
August 26, 2006, 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 ~J'1y(~~'
OWNER OPERATOR NO. X
X~~, (L.S.)
Wanda Rothrock
X
S.)
~.
010170880726 BM
DISCLOSURE FOR CONFESSION OF JUDGMENT
I/We, am executing this 25t~ day of
January , 2007 , a Judgment Note for Nine thousand three hundred twenty-
two dollars and 37/100 ($9 322.37 DOLLARS obligating me to repay that amount.
Initials: X~ ~
W.R.
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: X1~~ --
W.R
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~~~
W.R.
Initials:
. r
010170880726 BM
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 ~f-~~
Wanda Rothrock
Date: X 1 2~'1~ _
I
ACKNOWLEDGMENT
Commonwealth of Pennsylvania
County of
Before me, the undersigned Notary, personally appeared
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 Public
My commission expires on the
day of ,20
010170880726 BM
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. I/We 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, the undersigned have affixed their hands and seals on this
day of , 20
X~~ (SEAL)
Wan a Rothrock
(SEAL)
sworn to and subscribed before me
this day of ,20_.
Notary Public
• 4 ~r .~
010170880726 BM
CERTIFICATE OF RESIDENCE
The parties to the transaction are X (~ ~o~~ ~(1~RGL.K-
Name
X~ 10 ~'. C~IPnU~d ,C'arr~0 ~ll~
Address
X
Address
X
Address
I certify that these are the last known addresses of the parties to this matter.
By: X
Lonnie Ebersole
c/o Erie Insurance Group
Plaintiff
vs
Wanda Rothrock
Defendant
To: Wanda Rothrock, Defendant (s):
In the Court of Common Pleas
Cumberland County
Pennsylvania
Docket No. ~ 7• G 3 av
Civil Action
You are hereby notified that on ~,~~,~, .~ ~ , 2007, the following {8~er)
(free) (Judgment) has been entered against you in the above captioned case.
Date: ~~..'{~.~.~, ~~ ~ ~ / s ~ (1.~~~ ~ ~t vr~v
(Prothonotary) ~`
Wanda Rothrock
16 East Glenwood Drive
Camp Hill, PA 17011
A,, ew
1~... ~ ~
a ~
~„
~ C
°~, ~
fi ~
(~
C7 rv
t_ ~~:s
~ ~
-
--,., rt
4y
~ c~
~
' ~ ~~" ~ -r~
tr
) ,rn
-
, ~ ~
,
,.
~,. .-,
~..
'
,,. , .
~ la7 ._.} 17
.> ..
--e