HomeMy WebLinkAbout08-1365KIM A. SULTZBAUGH,
Plaintiff
VS.
KEITH A. SULTZBAUGH,
Defendant
: IN THE COURT OF COMMON PLEAS
: OF CUMBERLAND COUNTY, PA
CIVIL ACTION - LAW
: IN 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 action within twenty (20) days after this Complaint and
Notice are served, by entering a written appearance personally or by attorney and filing in
writing with the Court your defenses or objections to the claims set forth against you. You
are warned that if you fail to do so the case may proceed without you and a judgment may be
entered against you by the Court without further notice for any money claimed in the
Complaint or for any other claim or relief requested by the Plaintiff. You may lose money or
property or other rights important to you.
YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT
HAVE A LAWYER GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW. THIS
OFFICE CAN PROVIDE YOU WITH INFORMATION ABOUT HIRING A LAWYER.
IF YOU CANNOT AFFORD TO HIRE A LAWYER, THIS OFFICE MAY BE ABLE TO
PROVIDE YOU WITH INFORMATION ABOUT AGENCIES THAT MAY OFFER
LEGAL SERVICES TO ELIGIBLE PERSONS AT A REDUCED FEE OR NO FEE.
Cumberland County Bar Association
2 Liberty Avenue
Carlisle, PA 17013
(717) 249-3166
KIM A. SULTZBAUGH,
Plaintiff
VS.
KEITH A. SULTZBAUGH,
Defendant
: IN THE COURT OF COMMON PLEAS
: OF CUMBERLAND COUNTY, PA
NO.
: CIVIL. ACTION - LAW
: IN DIVORCE
AVLSO PARA DEFENDER Y RECLAMAR DERECHOS
USTED HA SIDO DEMANDADO EN LA CORTE. Si desea defenderse de las
quejas expuestas en las paginas siguientes, debe tomar accion con prontitud. Se le avisa que
si no se defiende, el caso puede proceder sin usted y decreto de divorcio o anulamiento puede
ser emitido en su contra por la Corte. Una decision puede tambien ser emitida en su contra
por cualquier otra queja o compensacion reclamados por el demandante. Usted puede perder
dinero, o propiedades u otros derechos importantes para usted.
Cuando la base para el divorcio es indignidades o rompimiento irreparable del
matrimonio, usted puede solicitar consejo matrimonial. Una lista de consejeros matrimoniales
esta disponible en la oficina del Prothonotary, en la Cumberland County Courthouse, One
Courthouse Square, Carlisle, Pennsylvania, 17013.
SI USTED NO RECLAMA PENSION ALuAENTICIA, PROPIEDAD MARITAL
HONORARIOS DE ABOGADO U OTROS GASTOS ANTES DE QUE EL DECRETO
FINAL DE DIVORCIO O ANULAMIENTO SEA MEITIDO, USTED PUEDE PERDER EL
DERECHO A RECLAMAR CUALQUIERA DE ELLOS.
USTED DEBE LLEVAR ESTE PAREL A UN ABOGADO DE INMEDIATO. SI
NO TIENE O NO PUEDE PAGAR UN ABOGADO, VAYA O LLAME A LA OFICINA
INDICADA ABAJO PARA AVERIGUAR DONDE PUEDE OBTENER ASISTENCIA
LEGAL.
Cumberland County Bar Association
2 Liberty Avenue
Carlisle, PA 17013
(717) 249-3166
K1M A. SULTZBAUGH, : IN THE COURT OF COMMON PLEAS
Plaintiff . OF CUMBERLAND COUNTY, PA
VS. No. p Fs - 13 6 ? c a ? : ( 4e-f&
KEITH A. SULTZBAUGH, : CIVIL ACTION - LAW
Defendant . IN DIVORCE
COMPLAINT UNDER SECTION 3301(c)OF THE DIVORCE CODE
COUNTI
AND NOW, this aIq' day of ? rx , 2008, comes the Plaintiff,
Kim A. Sultzbaugh, by her attorney, Jane M. Alexander, Esquire, and files this Complaint
upon a cause of action of which the following is a statement.
1. Plaintiff is Kim A. Sultzbaugh, 49 years of age, who currently resides at 806
Briarwood Lane, Camp Hill, Hampden Township, Cumberland County, Pennsylvania 17011.
2. Defendant is Keith A. Sultzbaugh, 55 years of age, who currently resides at 2749
Lisburn Road, Camp Hill, Upper Allen Township, Cumberland County, Pennsylvania 17011.
3. Plaintiff has been a bona fide resident in the Commonwealth for at least six months
immediately previous to the filing of this Complaint.
4. The Plaintiff and Defendant were married on July 1, 1989 in Shiremanstown,
Cumberland County, Pennsylvania by a Minister.
5. There were no children born between the parties.
6. There have been no prior actions of divorce or for annulment between the parties.
7. The parties have not entered into a written agreement as to alimony, counsel fees,
costs and property division.
8. Plaintiff has been advised that counseling is available and that Plaintiff may have
the right to request that the court require the parties to participate in counseling.
9. While the parties were domiciled within the Commonwealth of Pennsylvania, and
through no fault of Plaintiff, the innocent and injured spouse, the Defendant, in violation of
the marriage vows and the laws of the Commonwealth, has offered such indignities to the
person of the Plaintiff as to render her condition intolerable and life burdensome.
WHEREFORE, the Plaintiff prays your Honorable Court to enter a Decree of Divorce
from the bonds of matrimony.
COUNT II
10. The allegations of Paragraph one (1) through nine (9) are incorporated herein by
reference and made a part hereof.
11. The marriage is irretrievably broken.
WHEREFORE, the Plaintiff prays your Honorable Court to enter a Decree of Divorce
from the bonds of matrimony.
COUNT III
12. The allegations of Paragraph one (1) through eleven (11) are incorporated herein
by reference and made a part hereof.
13. During the marriage, Plaintiff and Defendant have acquired various items of
marital property, both real and personal, which are subject to equitable distribution under
Chapter 35 of the Divorce Code.
14. Plaintiff and Defendant have been unable to agree as to an equitable division of
said property.
WHEREFORE, Plaintiff requests your Honorable Court to equitably divide all
marital property of whatsoever kind and whosesoever situate and for such further relief as the
Court may deem equitable and just.
Respectfully submitted,
M. Alex[ &, Esqui
?.D. No. 07355
148 South Baltimore Street
Dillsburg, PA 17019
(717) 432-4514
Verification
I verify that the statements made in this Complaint in Divorce 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 unworn falsification to authorities.
DATE: ??? - -
A. Sultzbau
COMMONWEALTH OF PENNSYLVANIA
S.S.
COUNTY OF YORK
Before me, the undersigned officer, a Notary Public, in and for the said
Commonwealth and County, personally appeared Kim A. Sultzbaugh who, being affirmed
according to law, deposes and says that the facts and matters set forth in the foregoing
Complaint are true and correct to the best of her knowledge, information and belief.
AC4 A. Sultzbaugh
Sworn to and subscribed
before me this 2-!"-1 day
of -FeL c to , 2008.
Notary Public
COMMONWEALTH OF PENNSYLVANIA
Notarial Seal
Nanxnol Alexander, Notary Public
Iftburg eoro, York County
W Commission Expires Apr. 7, 2010
Member AgMliAtinn of Notaries
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In the Court of Common Pleas of
Cumberland County, Pennsylvania
No. Civil. 0r-
To
Prothonotary
19
Attorney for Plaintiff
i
4 No. Term, 19
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vs.
PRAECIPE
Filed 19
Atty.
SHERIFF'S RETURN - REGULAR
CASE NO: 2008-01365 P
COMMONWEALTH OF PENNSYLVANIA:
COUNTY OF CUMBERLAND
SULTZBAUGH KIM A
VS
SULTZBAUGH KEITH A
.;; KENNETH GOSSERT Sheriff or Deputy Sheriff of
Cumberland County,Pennsylvania, who being duly sworn according to law, .-
..?.. says, the within COMPLAINT - DIVORCE was served upon
SULTZBAUGH KEITH A the
DEFENDANT , at 0010:35 HOURS, on the 10th day of April 2008
at 3 LEMOYNE DRIVE
Y
LEMOYNE, PA 17043 by handing to
BARBARA DELAROSA SECRETARY
± a true and attested copy of COMPLAINT - DIVORCE together with
and at the same time directing Her attention to the contents thereof.
Sheriff's Costs:
Docketing 18.00
Service 15.00
Affidavit .00
Surcharge .00
Postage 41
3 3. 4 1
Sworn and Subscibed to
before me this day
of
So Answers:
R. Thomas Kline
04/11/2008
SRL
By:
A.D.
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY,
PENNSYLVANIA
HIM A. SULTZBAUGH,
Plaintiff
: NO. 08-1365
VS.
KEITH A. SULTZBAUGH,
Defendant
CIVIL ACTION-LAW
: IN DIVORCE
AFFIDAVIT OF CONSENT
1. A complaint in divorce under Section 3301(c) of the Divorce Code was filed on
March 3, 2008.
2. The marriage of plaintiff and defendant is irretrievably broken and ninety days have
elapsed from the date of filing and service of the Complaint.
3. I consent to the entry of a final decree of divorce after service of notice of intention to
request entry of the decree.
I verify that the statements made in this affidavit 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
unworn falsification to authorities.
_? - a?Q0
Date:
?Z .
Min Sultzbaugh
203E AUUIG 25 i-Ilh 12: i 0
rc , `':
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY,
PENNSYLVANIA
HIM A. SULTZBAUGH,
Plaintiff
: NO. 08-1365
VS.
KEITH A. SULTZBAUGH,
Defendant
: CIVIL ACTION-LAW
IN DIVORCE
WAIVER OF NOTICE OF INTENTION
TO REQUEST ENTRY OF A DIVORCE DECREE
UNDER CODE SECTION 3301(C) OF THE DIVORCE CODE
1. I consent to the entry of a final decree of divorce without notice.
2. 1 understand that I may lose rights concerning alimony, division of property, lawyer's
fees or expenses if I do not claim them before a divorce is granted.
3. I understand that I will not be divorced until a divorce decree is entered by the Court
and that a copy of the decree will be sent to me immediately after it is filed with the
Prothonotary.
I verify that the statements made in this affidavit 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
unworn falsification to authorities.
Date: 7 '
i A. Sultzbaugh
F LEO-
OF THE I
2064 A'.,G 2J It i,112: ' G
a 4,,
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY,
PENNSYLVANIA
HIM A. SULTZBAUGH,
Plaintiff NO. 08-1365
VS. : CIVIL ACTION-LAW
KEITH A. SULTZBAUGH,
Defendant IN DIVORCE
AFFIDAVIT OF CONSENT
1. A complaint in divorce under Section 3301(c) of the Divorce Code was filed on
March 3, 2008.
2. The marriage of plaintiff and defendant is irretrievably broken and ninety days have
elapsed from the date of filing and service of the Complaint.
3. I consent to the entry of a final decree of divorce after service of notice of intention to
request entry of the decree.
I verify that the statements made in this affidav' are true and correct. I understand that
false statements herein are made subject to the penalt' of 18 Pa. C.S. Section 4904 relating to
unsworn falsification to authorities.
Date:
/Keith A. Sultzbaugh
(T THE R.
[["G 99 AUG 25 1' -' i'x 12: 10
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY,
PENNSYLVANIA
HIM A. SULTZBAUGH,
Plaintiff
: NO. 08-1365
VS.
KEITH A. SULTZBAUGH,
Defendant
CIVIL ACTION-LAW
IN DIVORCE
WAIVER OF NOTICE OF INTENTION
TO REQUEST ENTRY OF A DIVORCE DECREE
UNDER CODE SECTION 3301(C) OF THE DIVORCE CODE
1. I consent to the entry of a final decree of divorce without notice.
2. I understand that I may lose rights concerning alimony, division of property, lawyer's
fees or expenses if I do not claim them before a divorce is granted.
3. I understand that I will not be divorced until a divorce decree is entered by the Court
and that a copy of the decree will be sent to me immediately after it is filed with the
Prothonotary.
I verify that the statements made in this affidavit are true and correct. I understand that
false statements herein are made subject to the penal 'e of 18 Pa. C S. Section 4904 relating to
unsworn falsification to authorities.
Date:
Keith A. Sultzbaugh
25 ?'i ?: 10
KIM A. SULTZBAUGH, : IN THE COURT OF COMMON PLEAS OF
PLAINTIFF : CUMBERLAND COUNTY, PENNSYLVANIA
VS. : NO. 08-1365
KEITH A. SULTZBAUGH, : CIVIL ACTION - LAW
DEFENDANT : IN DIVORCE
THIS AGREEMENT, made this 4 # day of
(.Ulf , 2009
by and between Kim A. Sultzbaugh of 806 Briarwood Lane Camp Hill, Hampden
Township, Cumberland County, Pennsylvania 17011 (hereinafter referred to as "WIFE") and
Keith A. Sultzbaugh, of 2749 Lisburn Road, Camp Hill, Upper Allen Township,
Cumberland County, Pennsylvania 17011 (hereinafter referred to as "HUSBAND").
WITNESSETH: WHEREAS, HUSBAND and WIFE were lawfully married on July 1,
1989 in Shiremanstown, Cumberland County, Pennsylvania. Kim A. Sultzbaugh instituted an
action in divorce to No. 2008-1365 in the Court of Common Pleas of Cumberland County,
Pennsylvania on March 3, 2008. The pleadings in the case requested dissolution of the
marriage between the two parties and for such further relief that the Court may deem equitable
and just; and
WHEREAS, the parties have reached an agreement as to the settling of all matters
relating to the divorce. There were no children born during this marriage.
NOW, THEREFORE, in consideration of the promises and the mutual promises,
covenants and undertakings hereinafter set forth and for other good and valuable
consideration, receipt of which is hereby acknowledged by each of the parties hereto, Kim A.
Sultzbaugh and Keith A. Sultzbaugh, each intending to be legally bound, hereby covenant and
agree as follows:
1. The parties intend to maintain separate and permanent domiciles and to live apart
from each other. It is the intent and purpose of this Agreement to set forth the respective
rights and duties of the parties while they continue to live apart from each other.
2. The terms of this Agreement and their effect have been fully explained to Kim A.
Sultzbaugh by her counsel, Jane M. Alexander, Esquire. Keith A. Sultzbaugh has been
advised by his counsel. Herbert G. Rupp, Jr.,Esquire. The parties acknowledge that they have
received independent legal advice from counsel of their choice and have been fully informed
as to their legal rights and obligations or have chosen not to do so. The parties understand the
facts and acknowledge and accept this Agreement as fair and equitable.
3. The parties have attempted to divide their matrimonial property in a manner which
conforms to a just and right standard, with due regard to the rights of each party. It is the
intent of the parties that such division shall be final and shall forever determine their
respective rights. The division of existing marital property is not intended by the parties to
constitute in any way a sale or exchange of assets, and the division is being effected without
the introduction of outside funds or other property not constituting a part of the marital estate.
4. Neither party shall molest, harass, annoy, injure, threaten or interfere with the other
party in any matter whatsoever. Each party may carry on and engage in any employment,
profession, business or other activity as he or she may deem advisable for his or her sole use
and benefit. Neither party shall interfere with the uses, ownership, enjoyment or disposition
of any property now owned and not specified herein or property hereafter acquired by the
other.
5. The consideration for this contract and agreement is the mutual benefits to be
obtained by both of the parties hereto and the covenants and agreements of each of the parties
to the other. The adequacy of the consideration for all agreements herein contained is
stipulated, confessed, and admitted by the parties, and the parties intend to be legally bound
hereby.
6. DEBTS OF THE PARTIES:
It is mutually agreed and understood by and between the parties that all joint debts
have been paid including open accounts, credit cards, and bank liabilities except as hereinafter
set forth:
6.1) The HUSBAND shall assume all liability for and pay and indemnify the WIFE
against liability for all debts and bills in his name alone, particularly those incurred.
since date of filing Complaint in Divorce.
6.2) The WIFE shall assume all liability for and pay and indemnify the
HUSBAND against liability for all debts and bills in her name alone, particularly those
incurred since date of filing Complaint in Divorce.
7. PERSONAL PROPERTY:
As to all items of personal property which the parties have divided to their mutual
satisfaction, henceforth, each of the parties shall own, have and enjoy independently of any
claim or right of the other party, all items of personal property of every kind, nature and
description and wherever situated, which are now owned or held by or which may hereafter
belong to the HUSBAND or WIFE, with full power to the HUSBAND or the WIFE to dispose
of same as fully effectually, in all respects and for all purpose as if he or she were not married.
Specific disposition of major items or personal property I as follows:
7.1) Bank Accounts:
Each party has opened and maintained their own separate bank accounts
since the time of separation. Neither party will make a claim against those funds.
7.2) Vehicles:
Each party owns their respective vehicles which are titles in their names
only and each shall retain possession and sole ownership of their vehicle and shall be
responsible for any debt thereon.
7.3) Household furnishings: The parties have divided the household
furnishings to their mutual satisfaction.
7.4) Pensions: Stock options, Retirement funds, IRAs:
Both parties renounce any claimed against the other's pensions, 401 K trust
funds or any similar property. If any documents need to be signed to confirm this renunciation
they shall be signed within thirty days of the request.
8. REAL ESTATE:
a) The Marital residence of the parties located at 806 Briarwood Lane, Camp Hill,
Cumberland Township, Pennsylvania 17011 is titled only in the name of the Husband.
However Wife has been residing in the property and wishes to continue to do so. The Parties
have entered into agreement whereby Husband will sell to the Wife said property for the
consideration of $160,000. The terms of the sale conform to the guidelines as set forth in the
parties Antenuptial Agreement dated June 23, 1989 and are further confirmed by an
agreement dated July 13, 2009.
9. SPOUSAL SUPPORT/ALIMONY:
Neither party has or will make claim for spousal support and/or alimony.
10. BANKRUPTCY:
The parties hereby agree that the provision of the agreement shall not be
dischargeable in bankruptcy and expressly agree to reaffirm any and all obligations contained
herein. In the event a party files such bankruptcy and pursuant thereto obtains a discharge of
any obligations assumed hereunder, the other party shall have the right to declare this
agreement to be null and void and to terminate this agreement in which the division of the
parties' marital assets and all other rights determined by this agreement shall be subject to
court determination the same as if this agreement had never been entered into.
11. STATUS OF SETTLEMENT:
The property settlement as provided herein between the parties shall be considered
an equitable distribution of marital property and both parties waive any and all rights or claims
which they may have been entitled to raise with respect to the issue of equitable distribution
under the Provisions of the Pennsylvania Divorce Act.
This Agreement does not modify the terms of the Antenuptial Agreement of June 23,
1989 nor does it void the agreement of June 29, 2009 regarding the transfer of the property at
806 Briarwood Lane, Camphill, Pa.
12. The parties agree that simultaneously with the signing of this Agreement they will
sign the necessary affidavits of consent and affidavits acknowledging notice of marriage
counseling in order to conclude the divorce action filed by WIFE/HUSBAND under the no-
fault provisions of the Pennsylvania Divorce Act.
13. The waiver or unenforceability of any term, condition, clause or provision of this
Agreement shall in no way be deemed or considered to be a waiver of or forfeiture of right to
enforce any other term, condition, clause or provision of this Agreement.
14. This Agreement shall be construed and interpreted according to the laws of the
Commonwealth of Pennsylvania.
15. It is understood and agreed that the heirs, administrators, executors and assigns of
the parties hereto shall be bound by all the terms, conditions, clauses and provisions of this
Agreement.
IN WITNESS WHEREOF, the parties hereto have set their hands and seals the day
and year first above written, intending to be legally bound.
BY:
M. Ale)Eander, Esquire
ttorney for Plaintiff
COMMONWEALTH OF PENNSYLVANIA :
th A. Sultzbaugh,
SS
COUNTY OF
On this, the o2 `C r " day of 2009, before me the
undersigned officer, a Notary Public, in and for said Commonwealth and County, Personally
appeared Kim A. Sultzbaugh, know to me (or satisfactorily proven) to be the person whose
name is subscribed to the foregoing Marriage Settlement Agreement and in due form
acknowledged that she executed the same for the purpose therein contained and desired the
same to be recorded as such.
WITNESS my hand and notarial seal the day and year aforesaid.
otary Public
-COMMONWEALTH OF PENNSYLVANIA
My Commission Expires: NotMal Seal
Gonda M. iNet * Oon, Notary Public
Camp HUI eoro, Cumbedand County
MY Commission Expires Dec. 27, 2010
Member, Pennsylvania Association of Notaries
f Sultzbau , Pla' iff
nj
COMMONWEALTH OF PENNSYLVANIA :
SS
COUNTY OF
On this, the o2 day of 2009, before me the
undersigned officer, a Notary Public, in and for said Commonwealth and County, :Personally
appeared Keith A. Sultzbaugh, know to me (or satisfactorily proven) to be the person whose
name is subscribed to the foregoing Marriage Settlement Agreement and in due form
acknowledged that he executed the same for the purpose therein contained and desired the
same to be recorded as such.
WITNESS my hand and notarial seal the day and year aforesaid.
L&U-U? h/12k?
Notary Public
My Commission Expires:
COMMONWEALTH OF PENNSYLVANIA
Notarial Seal
Olerxia M. WeltOngton. Notary Public
Cam Hill Boro, Cumberland County
My Commission Expires Dec. 27, 2010
Member, Pennsylvania Association of Notaries
FIL ;,.
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2009 AU,,3' 42 1 F 11 + l : 10
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HIM A. SULTZBAUGH, : IN THE COURT OF COMMON PLEAS OF
Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA
VS. : CIVIL ACTION -LAW
KEITH A. SULTZBAUGH, : IN DIVORCE
Defendant : NO. 08-1365
PRAECIPE TO TRANSMIT RECORD
To the Prothonotary:
Transmit the record, together with the following information, to the court for entry of a
divorce decree:
1. Ground for divorce: irretrievable breakdown under section (3301(c)) (?)(1)) of
the Divorce Code. (Strike out inapplicable section).
2. Date and manner of service of the complaint: Served APril 10, 2008
by Deputy Sheriff
3. Complete either paragraph (a) or (b).
(a) Date of execution of the affidavit of consent required by section 3301(c) of the
Divorce Code: by plaintiff 7-27-09 ; by defendant 8-24-09
(b)(1) Date of execution of the affidavit required by section 3301(d) of the Divorce
Code: ; (2) Date of filing and service of the plaintiff's affidavit upon the
respondent:
4. Related claims pending:
5. Complete either (a) or (b).
(a) Date and manner of service of the notice of intention to file praecipe a copy of
which is attached:
(b) Date plaintiff's Waiver of Notice was filed with the Prothonotary: 8-25-09
Date defendant's Waver of Notice was filed with the Prothonotary: 8-25-09
2009 >"jG 2J FV 12*- ? I
KIM A. SULTZBAUGH
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
V.
KEITH A. SULTZBAUGH NO 08-1365
DIVORCE DECREE
AND NOW, S at?MbLr ?. DDq , it is ordered and decreed that
By the Court,
KIM A. SULTZBAUGH
plaintiff, and
KEITH A. SULTZBAUGH , defendant, are divorced from the
bonds of matrimony.
Any existing spousal support order shall hereafter be deemed an order for
alimony pendente lite if any economic claims remain pending.
The court retains jurisdiction of any claims raised by the parties to this action
for which a final order has not yet been entered. Those claims are as follows: (If no
claims remain indicate "None.")
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IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
CIVIL ACTION - LAW
Kim A. Sultzbaugh
NO. 08-1365
CIVIL
PLAINTIFF
VS.
ACTION IN DIVORCE
Keith A. Sultzbaugh ,
DEFENDENT
NOTICE OF ELECTION TO RETAKE FORMER NAME
Notice is hereby given that the Plaintiff in the above matter having been granted a
Final Decree in divorce from the bonds of matrimony on the 1st day of SePtgnber
20 09, hereby elects to retake and hereafter use her previous name of
Kim Ann Hileman
COMMONWEALTH OF PENNSYLVANIA :
COUNTY OF CUMBERLAND : SS.
On the /6l day of 206 before, a Notary Public, personally
appeared Kim A. Sultzbaugh known to me to be the person whose name is subscribed to the
within document, and acknowledged that she executed the forgoing for the purpose therein
contained.
IN WITNESS WHEREOF, I have hereunto set my
(Signature - marri na
Kim Ann Sult aug
(Signature - to be known as)
Kim Ann Hileman
SALLY J. KITCHEN, Notary Public
City of Harrisburg, Dauphin County
CAF THE R , . > CITAPY
2099 Std' 18 A 11: 56
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