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HomeMy WebLinkAbout04-1354IN THE VS. k -ac-'AU 1". 1 C'`I PENNSYLVANIA DOCKET NO.0 "1,36 YOF IN FORMA PAUPERIS STATEMENT the Petitioner Pro Se:, hereby states under the penalties provided by 18 Pa. C.S.A. Section § 4904 (unswom falsification to authorities) that: 1. I am the Petitioner in the above captioned matter and that because of my financial condition I am unable to pay the following fees and costs of prosecution in this matter. 2. My responses to the questions below relating to my ability to pay the fees and costs are true and correct to the best of my knowledge, information and belief. / (A) Are you presently employed YES O NO d r (1) If the answer is YES, state the amount of your salary or wages per month and give the name and address of your employer (2) If the answer is NO, state the date of last employment, salary or wages earned. ,)'C*ot 311 5,0C, VpC"'\Y (I3) Have you received within the past 12 months any income from a business, profession or other form of self employment, or in the form of rent payments. interest, dividends, pensions, annuities, social security benefits, support payments or other viable source? YES +NO O (1) If the answer is YES, describe the source of income, and state the amount received from each source during the last 12 months. (C) Do you have a checking account? YES O NO (l) If YES state the amount in each account. (D) List the persons, (if any) who are dependent upon your support and state their relationship to you. (It' (E) List all outstanding debts and obligations. (3) 1 understand that any false statements or answers made herein will subject me to the penalties provided by law under Pa.C.S.A. § 4904 (misdemeanor of the second degree) DATED: jJ ... ? ,` ? ?.a =h t ... x'. 11"'. ' 1? ?' t ., } ; '?. l _ ?.? ". ' , _ ? . ? . . , oy ./3,5 y Plaintiff VS. De endant * IN THE COURT OF COMMON PLEAS OF Cvtn?hQrl??a COUNTY , PA * * CIVIL DIVISION * (In Re: Divorce) * NO: * COMPLAINT UNDER SECTION 3301(c) OR 3301(d) OF THE DIVORCE CODE AND NOW, comes Plaintiff, J(??(1 T('?' pr se, bringing the following complaint in divorce, averring in support as follows: 1. Plaintiff is `j(??1R <C*y who current- tt. ly resides at Q'19.,2)ox (Address) ?Ch?/1?,??cr P_a since c?(?Cl_C?CII (City) (State) (Date) 2. Defendant ly resides at Lk" C'rarl', aka (City) 3. Plaintiff is (',ro_vA(a Vf who current- (Address) since (State) (Date) has been a bona fide resident in the Com- monwealth for at least six months immediately previous to the filing of this Complaint. 4. Plaintiff and Defendant were married on '1-5 - 9R (Date) at k)au,?,.t(a , PA . (City) (State) 5. There have been no prior actions of divorce or annul- ment between the parties. 6. The marriag? is irretrievably broken. 7. Plaintiff has been advised that counseling is avail- able and that Plaintiff may have the right to request that the court require the parties to participate in counseling. 8. Plaintiff requests the court to enter a decree of divorce. I, ,)c)nn verify that the state- (Plaintift) ments made in this Complaint are true and correct. I under- stand that false statements herein are made subject to the penalties of 18 Pa.C.S.A. § 4904, relating to unsworn falsifi- cation to authorities. Respectfully submitted: Jai tiff) DATE: F -2- c X'XlC1 \ ?f'?I c?C. (IN THE COURT OF COMMON PLEAS OF PL3[NTIFF. ( CA?'Z?F?9.1T ,Gc?c? V. (CIVIL DIVISION Q)au,ac. V, DEFENDANT. (NO: COMPLAINT IN DIVORCE COUN"IY, PENNSYLVANIA AND NOW COMES, the Petitioner, KX?r P. t %l . by FILING PRO SE, who files this Complaint in Divorce a statement of which is as follow: f 1. The Petitioner is tJ[ r) \ t (??I an adult individual currently residing at 9-,0. a fox 4qNSC, 1cr? x,.11a P_ia \1C2,ti-t 2. The Defendant is ?'?MCIWV, k 1?c'%f . an adult individual currently residing 3. The Petitioner has been a bona fide resident of the Commonwealth of Pennsylvania for at least sie (6) months previous to the filing of this Complaint. 4. The Petitioner and Respondent were married an date: Jv& rr. S, t:t5%f9 in the State of Q01 S. There (is) are _ child(ren) born of this marriage. Name(s) K 1? Birthdate(s): 6. Neither parry is a member of any branch of military. 7. The marriage is irretrievably broken. 8. The Petitioner, A-Vin P. V ,y respectfully requests this Honorable Court to a grant this Divorce pursuant to Section 3301 (c), or in the alternative, Section 3301 (d) of the Divorce Code. Respectfully submt ed, Name: n P. t C' y Full Address: -% t ) g ?116K t`\Qs G l c) ?M cl VA 1101-t`t Telephone: `'16) lA? 3`? 1 I verify that the.statements made in the Complaint are true and correct. I understand that false statements made herein are subject to penalties of 18 Pa. C.S.A. Section 4904, relating to unswom falsification to authorities. Dated: Q - O--c)a m} ?J O 77 IN THE COURT OF COMMON PLEAS OF r CU(nh°r Je^A COUNTY, PENNSYLVANIA Plaintiff VS- No. ()q -135/ Lfendant ACCEPTANCE OF SERVICE AND ENTRY OF APPEARANCE TO THE PROTHONOTARY: I hereby accept service of the Complaint in Divorce and enter my appearance for Defendant in the above captioned matter. Defendant !• 4evern t ' •• w??r7 to DAWN NOTARIAL SEAL M.SHUGHART Carlisle Cumberland otary publfo My Commission Ex , County te; r?er• z$ F ?' O ?? -c: _ . -i 7= -r, ' `r- ,.-, _. r,? r -, i? ?; v. PLAINTIFF. ?tbs , c1?, 1E, . ?r c?tl DEFENDANT. 09-i33q ? I`: T'r.c COi:RT OF CO%I%tO`: PLEAS OF ( (C.tx?hor\?ac,r?, ( (CML DMSION ( (NO: AFFIDAVIT CONEMOMVEALTH OF PENNSYLVANIA COUNTY OF: C ?barlac? COUNTY, PENNSYLVANLA. ss: t?@l- 56-65 "to Before me, the subscriber, a Notary Public in and for said Commonwealth and 11 County, personally appeared 'Ar hn P. )?t`? . who being duly sworn according to law, deposes and says that the facts contained within the foregoing Complaint in Divorce are true and correct to the best of his/her knowledge, information, and belief, and that he/she is authorized to make this Affidavit. U V Name Sworn to and subscribed before me this . o ?. +ery 200 , . No(aryi Seal JoAnne q. Bickel, Notary PubMc I Conneaut 7wp., Erie County _ OJ ? ' ?i?/? MY Co<hmission Expires Sept. 23, 2006 Member, Pennsylvania Association ?f Notaries NOTARY PUBLIC F `-? (? ?? -r _?l y '? ..??U =?? , %7r't7 i -._ :': ?:-?j i G± vJ 0 4 -13.5 N C??hn -? PLAI TIFF VS. Vim/ DEFENDANT on this day of and correct copies of the person(s) listed receipt required, in C Procedure, Rule 403. IN THE COURT OF COMMON PLEAS OF CLtr1D¢1-1Ck,-A COUNTY, PENNSYLVANIA CIVIL DIVISION No: CERTIFICATE OF SERVICE hereby certify the foregoing documents to below via "CERTIFIED U.S. omplaince with Pensylvania P Office of the Prothonotary that I have caused true be made upon MAIL" return ules of Civil original & 1 Copy 1 Copy NAME: t, ? ADDRESS: Rp+z GSOX 4`6 Cy P_l, no-v1 h? !l '1"1 i.' ??. ? . ?.i t r?rt ? Y ? ? ? ? -.. ,_,._ -, J py-135 1?LAINTIFF VS. v"- vo DEIENDANT IN THE COURT OF COMMON PLEAS OF ??tY1rcnc? COUNTY, PENNSYLVANIA : CIVIL DIVISION : No: UNSWORN DECLARATION I, ?n P. vpz/ hereby declare that the facts set forth in the foregoing documents are true and correct to the best of my personal knowledge, information, and belief. I further declare that any fasle statements made herein are subject to the penalties of perjury under 18 Pa. C.S.A. § 4904 of the Pennsylvania Crimes Code, relating to unsworn falsification to authorities. Dated: 1?- kj -6`a NAME: ADDRESS: 1©k? .l l? P ? t???l ._.> - ,.., - ? " , ?` -- ? -- '-.;;T t_.) i J G? ?'r-1 -1 :- _?.: c_I 0y-)35y ( IN THE COURT OF COMMON PLEAS OF PLAINTIFF, DEFENDANT. ( Ct,ty-%Q rkrxox1 (CML DMSION ( NO: ACKNOWI FDGFMF.NT COUNTY, PENNSYLVANIA A complaint in Divorce under Section 3301 (c) of the Divorce Code was filed on 1 ?2 1 -N_• I agree that the marriage of the Plaintiff and Defendant is irretrievably broken and ninety days have elapsed from the date of filing the Complaint. All information contained within the attached documentation is true and correct to the best of my knowledge, information, and belief. It is my desire to file with the (%k x-nULAC?r'4 County Court of Common Pleas the attached Marital Property Settlement Agreement and to be bound fully and completely by the terms and conditions as set forth within said Marital Property Settlement Agreement documentation. IN WITNESS WHEREOF, I set my hand and seal this ,-9,) day of SP, A.) . . 200 t'l , NAMl t On this day 0 `??2f/ry 200 ?-/ before m , a Notary Public, the undersigned officer, personal y appeared AME I /- tt//? A known to me to be the person whos name is subsc ' ed to the written instrAme , and acknowledged that she executed the same for the purposes therein contained. IN "SS Wl IEREQ&niktunto set m hand and official seal. .lo Anne R. Eckel, Notary Public Conneaut Twp., Eno County My Commission Expires Sept. 23, 2006 Pennsytvania Association Of to ies otary Public 41, Oq -/35y PLAINTIFF, V. V,-)M lc?'A w? _ V- ,/ DEFENDANT. ( IN THE COURr OF COMMON PLEAS OF ( e??t?'1?EJ2C`GtYS (CIVIL DIVISION (NO: AFFIDAVIT OF CONSENT COUNTY, PENNSYLVANIA A complaint in Divorce under Section 3301 (c) of the Divorce Code was filed on (date:)/1l / 2. The marriage of the Plaintiff and Defendant is irretrievably broken and ninety days have elapsed from the date of filing and 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. WAIVER OF NOTICE OF IN'T'ENTION TO REQUEST ENTRY OF A DIVORCE DECREE UNDER SECTION 3301 (c) OF THE DIVORCE CODE 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 here- in are made subject to the penalties of 18 Pa C.S. Section 4904 relating to unswom falsification to authorities. Date: iS_ Plaintiff / c> (' ll _ ' _? -i ' .% -?- ' ? i i _^ (T f..) 1 -? l? _(t T1 p -? 1;., _ Curtis R. Long Prothonotary Office of the Protbonotarp Cumberianb Countp Renee K. Simpson Deputy Prothonotary John E. Slike Solicitor n4l - 13.Sq CIVIL TERM ORDER OF TERMINATION OF COURT CASES AND NOW THIS 5TH DAY OF NOVEMBER 2007 AFTER MAILING NOTICE OF INTENTION TO PROCEED AND RECEIVING NO RESPONSE - THE ABOVE CASE IS HEREBY TERMINATED WITH PREJUDICE IN ACCORDANCE WITH PA R C P 230.2. BY THE COURT, CURTIS R. LONG PROTHONOTARY One Courthouse Square • Carlisle, Pennsylvania 17013 • (717) 240-6195 • Fax (717) 240-6573