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'LED 0- 017-010171020851 SG
HE PRO
it , I TWA—
2,311 SEP 16 PMT 2: ?18 JUDGEMENT NOTE
Pennsylvania, 4/14/2009 , $3,882.8:
PENNSYLVANIA
FOR VALUE RECEIVED, I/we promise to pay to the order of Erie
tin
the sum of Three thousand eight hundred eighty two and 85/100
payable said sum to be as follows: Two- hundred dollars, ($200.00)
May 2009 and One-huddred dollars, $100.00 on the 1st day of
thereafter until the entire amount is paid in full.
Uwe hereby authorize and empower any attorney of any Court of Reci
or elsewhere, to appear for and confess Judgment against me for the si
hereon, pursuant to PA. R.C.P. 2951 (a) (1) with or without declaratio
suit, interest at the rate of 6% per annum, an attorney's fee, release of
stay of execution; and Uwe also waive the right of inquisition on any r
be levied upon to collect this note; and Uwe do hereby voluntarily con
authorize the Prothonotary to enter said voluntary condemnation upon
that may be issued to collect said Judgment; and Uwe further agree tha
be sold on a Fieri Facias, and Uwe do hereby waive and release all reli
appraisement, stay of execution, exemption or tcy laws of this
now in force or hereafter to be passed. 11
'IV,, J
? ? IbS30
sum to be
the 1st day of
month
-d of Pennsylvania
n due and payable
, with costs of
-rors, and without
a1 estate that may
emn the same and
my Fieri Facias
said estate may
f from any and all
r any other state
(L.S)
This note is given executed without duress or coercion and with full an complete
understanding that upon failure to make payment as agreed, that my op rating privileges
may be suspended.
Further, I do hereby acknowledge that the damage incurred in the
February 12, 2009, for which this note is given resulted from my
and I do hereby acknowledge and waive my right to any heari }gam
DRIVER DATE OF BIRTH X I j X
DRIVER OPERATOR NO. X_4066 Jenn
OWNER DATE OF BIRTH X X
OWNER OPERATOR NO. X
(L.S.)
L.S.)
604 so pd
?BYe
IVAA-,,® iAMi/ad
of
ce and fault,
that issue.
017-010171020851 SG
I/We, Jennifer L. Sirois am executing this 14th day of A ril . 2009 , a
Judgment Note for Three thousand eight hundred eighty two and 8 /100 ($3,882.85
)
DOLLARS obligating me to repay that amount.
Initials: X
Initials:
.S.
It has been explained to me by representative of the Erie Insurance Gr p that the Note
contains wording that may permit them or their attorneys to enter Jud ent against me at
the Courthouse, whether or not said Note is in default, without notice t me and without
offering me an opportunity to defend against the Entry of Judgment, and that the
Judgment may be collected by any legal means.
Initials:
Initials:
J.S.
In executing the Note, I/We am knowingly, understandingly, and volun ari ly waiving any
rights to resist the Entry of Judgment against me at the Courthouse, and consenting to
the Confession of Judgment.
Initials
L 112
J.S.
Initials:
017-010171020851 SG
I certify that my annual income exce 's less than) TEN THOUSA]
DOLLARS, that the blanks in this disclosure were filled in when I inil
and that I received a copy at the time of signing.
X
Date: X a/u 1
Jennifer
ACKNOWLEDGMENT
Commonwealth of Pennsylvania )
County of -? WL ,i/ )
Before me, the undersigned Notary, personally appeared .7G--N NZ Fi
, whose initials appear above, and who ac
oath that they executed the above Disclosure for Confession of Judgmc
the Confession of Judgment Note referred to in the First Paragraph of t
this date.
COMMONWEALTH OF PENNSYLVANIA
Notarial Seal
(SEAL) Mary Anne Naugle, Notary Public
Susquehanna Twp., Dauphin County
My Commission E)ires Apd! 9, 2011
Member, Pennsylvania As,4,,JaWn of Notaries
AND 001100
d and signed it,
Dwledges under
together with
Disclosure on
My commission expires on the q 14-1 day of/40/ZLL ,20j
017-010171020851 SG
Being duly sworn according to law, the undersigned jointly and
that:
1. I/We are over twenty-one years of age, not within the mi
United States and its allies nor otherwise within the civil
the Soldiers and Sailors Civil Relief Act of 1947 as amen
2. I/We have delivered to Erie Insurance a Judgment Note
confession of judgment to secure certain payment oblig
depose and say
r service of the
f provision of
ininiz a
3. I/We understand that a confession of judgment allows for t 4e entry of a
judgment by confession against them and that saidjudgrner?' 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 complete the
transaction as provided, the undersigned have affixed their hands ajl:d seals on this
day of , 2009
_ _(SEAL)
^,aIiWIU 11 r. _; k,)i NNSYLVANIA
Sworn to and subscribed before me Seal
L Mary n` angle e, Notary Anne nno Public
This Is )I- day of M,cZc ,20oef Susqu hann<a'r Dauphin County
MY( o. niissiln s Apri! 9, 2011
Mep? et ^;;t v uc+aNOn of Notaries
N
017-010171020851 SG
CERTIFICATE OF RESIDENCE
The parties to the transaction are X Q i\
Xa.Y?
Address
v
Address
Aaaress
I certify that these are the last known addresses of the parties tot 's matter.
By: X
Erie Insurance Group } In the Court of C on Pleas
Plaintiff } Cumberland Cou y
} Pennsylvania
vs
Jennifer L. Sirois
Defendant
To Jennifer L. Sirois, Defendant (s):
Docket No.
Civil Action
You are hereby notified that on L 1 , 2010
(Decree) (Judgment) has been entered against you in the above cap
7?-o I au I
following (Order)
case.
Date: ? " / (O //
Jennifer L. Sirois
16 Altoona Ave.
Enola, PA 17025-2501
• t t., fw,ot.ttt. t ■,. r'lt,Ify,o
Matthew Zettlemoyer & En the: Court of Common Pleas Of
Jennifer Zettlemoyer
l'tttnbe.rlantl ( 'otu►ty, Pennsylvania
Jennifer Sirois f,r,4Sn nt in fig r „f Plaintiff nn _._4114`2009
for 5-3882 . 85
-- a
;,,11-720 2 Civil rctm, 2011
_.--
Entered _S_eptember _16-,_-2011 -
Erie Insurance Exchange Plaintiff
in the above Judgment, .lo appear and acknowledge that on this day have had and received and
from .lenn� f�r__Sir_Qi_s
the defendant in the above Jud ncnt, full payment and naisfaction of the sar.ie_ with interest and costs, and desired that
satisfaction therefore shall be entered upon the records thereof. •
And further, I do hereby authorize and empower David D. fBue I L
theProthonotary of said Court, to appear ___for ine
and in tllY name and stead to enter full satisfaction upon the record of said Judgment, as fully and effectually, to all
intents and purposes, as L could were I personally present in person to do so. And for so doing this shall be
your sufficient warrant of authority.
In testimony whereof, we have hereunto set our hands and seals this 29th
day of _ Ja n u a-r-y A• 0 - I
Christy Smye arrisburgir St ( Ytisor
State of Pennsylvania -<r,+�';__-c __ {'goa l)
r._ wet -
c .
County of Cutabr-eland, >
Personally appeared before me, the subscriber, Ct1XJ- t_y__sSm lYers
the Plaintiff in the
above ,juts;rncnt, and in due form of law acknowledged the within and foregoing Power of Attorney to satisfy the judg-
ment se, forth, to he an act and deed, and desired that tha sank shall he filed of record in the office of the Prothon-
otary of the Court of Common Pleas of said County.
In :c'h:n':ny ..whereof, I hose ;•t my hard and sal this actill, rr�f 4...r
SUZANNE f:74"-" [ ( 01(f
M.W;i ANO,D:c::
Mechanicsburg Borough,CUri:. ti ..,.. .
My Commission Expires h'ottorrt�,:1,