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HomeMy WebLinkAbout12-2339 la - OW9 61vi/ ler'm IN THE COURT OF COMMON PLEAS :-q ED OF THE 37th JUDICIAL DISTRICT OF PENNSYLVANIA FOREST COUNTY BRANCH 1011 APR I I P ER: 51 CIVIL GRIST COUNTY : URT HOUSE DOUGLAS AVERY, Plaintiff vs. No. 55 of 2012 PENNSYLVANIA DEPARTMENT OF CORRECTIONS,z T? SCI-CAMP HILL, Defendant ORDER ; AND NOW, this 5 h day of April, 2012, upon consideration of Plaintiff's Petition for Leave to Proceed in Forma Pauperis and Affidavit in Support of Petition for Leave to Proceed in Forma Pauperis, it is hereby ORDERED and DECREED that the above matter is hereby transferred to the Court of Common Pleas of Cumberland County, Pennsylvania. The Prothonotary is hereby directed to forward to the Prothonotary of Cumberland County certified copies of the docket entries, process, pleadings, and other papers filed in this action. RV T14P f YIT T11? T- C O U R T OF C O M M O N P L E A S COUNTY OF FOREST CIVIL DIVISION I, Dawn M. Millin PROTHONOTARY in and for said County and State, do hereby certify to the best of my knowledge, information and belief that the following is a true and correct copy of the record. DOUGLAS AVERY VS PENNSYLVANIA DEPARTMENT OF CORRECTIONS, CAMP HILL C.D. 455 OF 2012 IN TESTIMONY WHEREOF, I have hereunto set my hand and official seal of the Said Court, this the 11th day of April A.D. 2012. Dawn M. Milliri 1413100.4112012 Forest County Prothonotary Pagge 1 PYS835 Docket Entries 4/11/2012 Cover Sheet Case No 2012-00055 Plaintiff: AVERY DOUGLAS JU7684 ** (VS) ** CO;A&j,-tr-Nu,LTH OF Wit, COUNTY OF FOREST A I HEREBY CERTIFY thIAf The WITHIN MWAENT TRUE AND CORRECT C OF S DiA1F: Defendant: DEPARTMENT OF CORRECTIONS CAMP HILL 14131004112012 Forest County Prothonotary P qqe 2 • PYS835 Docket Entries 4?I1/2012 Case No 2012-00055 DOUGLAS AVERY (VS) CAMP HILL Date Filed - - - - - - - - - - - - - FIRST ENTRY - - - - - - - - - - - - - - 1 3/29/12 PETITION TO PROCEED INFORMA PAUPERIS FILED - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 2 4/11/12 ORDER FILED AND NOW THIS 5TH DAY OF APRIL 2012, UPON CONSIDERATION OF PLAINTIFF'S MOTION FOR LEAVE TO PROCEED INFORMA PAUPERIS AND AFFIDAVIT IN SUPPORT OF PETITION TO PROCEED IN FORMA PAUPERIS, IT IS HEREBY ORDERED AND DECREED THAT THE ABOVE MATTER IS HEREBY TRANSFERRED TO THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA. THE PROTHONOTARY IS HEREBY DIRECTED TO FORWARD TO THE PROTHONOTARY OF CUMBERLAND COUNTY CERTIFIED COPIES OF THE DOCKET ENTRIES, PROCESS, PLEADINGS, AND OTHER PAPERS FILED IN THIS ACTION. BY THE COURT: GREGORY J. HAMMOND, J. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 3 4/11/12 MAILED COMPLETE COPY OF CASE TO CUMBERLAND COUNTY - - - - - - - - - - - - - - LAST ENTRY - - - - - - - - - - - - - - IN TBETCfJ , COMMON PLEAS OF THE 37T" JUDICL A RICT OF PENNSYLVANIA FOREST COUNTY BRANCH ZOiZ MAR 29 0INS156 a? "'EST COUNTY PLAINIFF 'J tR T HOUSE NO: 55 56 ?)O l oq-? VS. CW=10' A ? DEFENDANT PETITION FOR LEAVE TO PROCEED IN FORMA PAUPERIS AND NOW,this ,C-V day of Co L' 2009, comes your Petitioner rY„ss cj v and files this Petition for Leave to Proceed In Forma Pauperis in the above captioned matter, and in support thereof avers as follows: 1. Petitioner is _ o v A,, e - .ap residing at ocS?-? ?c^?\ S <,a: Petitioner is the Plai efen ant, in the above captioned matter, and because of her/his financial condition is unable to pay the fees and costs of prosecuting/defending the action or proceeding. 3. Petitioner has attached hereto as exhibit "A" the affidavit required by Pa.R.App.P. 552 Wherefore, your Petitioner respectfully requests that this Cowt grant her/him leave to proceed in forma pauperis. Respectfully Submitted, Petitioner IN THE COURT OF COMMON PLEAS OF THE 37' JUDICIAL DISTRICT OF PENNSYLVANIA ' FOREST COUNTY BRANCH CIVIL ZQIZ MAR 29 A 9: 32 A?k PL IFF Vs. NEST COUNTY RT yous NO: 55 ap f 5? DEFENDANT AFFIDAVIT IN SUPPORT OF PETITION FOR LEAVE TO PROCEED IN FORMA PAUPERIS 1. I am the Plaintiff in the above matter and because of my financial condition am unable to pay the fees and costs of prosecuting or defending the action or proceeding. 2. I am unable to obtain funds from anyone, including my family associates, to pay the costs of litigation. 3. I represent that the information below relating to my ability to pay the fees and costs is true and correct. (a) Name: '?iunlc?? AuPcY, 1-'Iennor-e, ?Rhmu - Address: -1A- Social Security Number77,>_v`---cVg " ;4?p Cff (b) Employment If you are presently employed, state: Employer: Address:_ Salary or Wages per month: Type of Work: If you are presently unemployed, state: Date of last employment: Salary of wages per month: Type of work: © Other income within the past twelve month Business or profession: Other self-employment: 2 LAS - 5/8-- 67C d Interest: Dividends: Pensions and annuities: Social Security benefits: ' 004- 0?e? & ca-c. \ &C-Q rrvi qo n .J?N S Support payments:' ac 4 P-t C) Disability payments: Unemployment compensation and supVlemental benefits: Workman's compensation: Public Assistance: Other: (d) Other contributions to household support: (Wife)(Husband) Name: If your (wife)(husband) is employed, state Employer: Salary or wages per month:_ Type of work: Contributions from children: Contributions from parents: Other contributions (e) Property owned Cash: Checking account: Savings account: Certificates of deposit: Real Estate(including home):. Motor Vehicle: Make Year Cost Amount owed Stocks;bonds: Other: (f) Debts and obligations Mortgage: Rent: Loans: 3 Other: (g) Persons dependent upon you for support (Wife)(Husbnd) Name: Children if anv: Name: Other persons: Name: Relationship: Age 4. I understand that I have a continuing obligation to inform the Court of improvement in my financial circumstances which would permit me to pay the costs incurred herein. 5. 1 verify that the statements made in the affidavit are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S.A. 4904, relating to unsworn falsification to authorities. Date: 3-- a 5- ,Z ORDER Petitioner AND NOW, this-.day of ?20 1 I ,the Praecipe to Proceed in Forma Pauperis is BY THE COURT Judge 4 r i FOREST COUNTY REGISTER, RECORDER PROTHONOTARY & CLERK OF COURTS FOREST COUNTY COURTOHUSE 526 ELM ST #2 TIONESTA, PA 16353 814-755-3526 PHONE 814-755-8837 FAX March 22, 2012 Douglas Avery Jr. #J47684 SCI Forest P.O. Box 945 Marienville, PA 16239 Mr. Reese, We received your complaint, there were no fees attached. All filings received in our office must either include payment of filing fees or and order of court granting Informa Pauperis status. Enclosed us an application to proceed Informa Pauperis, or without paying. Please return these completed forms to our office, the Judge will either approve and sign an IFP Order or it may be denied. If denied, you will have 30 days from the date of his Order denying IFP to send in the money due for filing the Original paperwork. The fee involved is $89.00 If this is not paid within thirty (30) days, our office will have to enter a Judgment of Non Pros against you. If you have any questions you can contact us at 526 Elm St. #2 Tionesta, PA 16353 Thank you, Miriah L. Tkach Deputy Clerk of Courts • ,r S: E C T' I v: N`: A Supreme Co nnsylvania COU leas For Prothonotary Use Only: Docket No: L EJ y Q. County I LUIL MA The information collected on this form is used solely for court administration purposes. This f does not cunnlement nr rpnlacp the frlinv and spi-vicp ofnleadinps or other naners as required by laws or as ot4Ntr w C encement of Action: om „ U R T H O E GKomplaint D Writ of Summons 0 Petition 0 Transfer from Another Jurisdiction 0 Declaration of Taking Lead Plaintiff's Name: Lead Defendant's Name: sAt 126,4w?? - P La « G+? n S C t-?, - Are money damages requested? Yes 0 No Dollar Amount Requested: Mpr'ithin arbitration limits (check one) 3'$0)000 10outside arbitration limits Is this a Class Action Suit? 0 Yes WNo Is this an MDJAppeal? 0 Yes E (No Name of Plaintiff/Appellant's Attorney: 1-baw r'1 H . 0 Check here if you have no attorney (are a Self-Represented (Pro Se] Litigant) Nature of the Case: Place an "X" to the left of the ONE case category that most accurately describes your PRIMARY CASE. If you are making more than one type of claim, check the one that you consider most important. (do not include Mass Tort) tentional [3-Malicious Prosecution 0 Motor Vehicle 0 Nuisance 0 Premises Liability 0 Product Liability (does not include mass tort) 0 Slander/Libel/ Defamation 0 Other: CONTRACT (do not include Judgments) E ]Buyer Plaintiff O Debt Collection: Credit Card 0 Debt Collection: Other S E C T I O N B 0 Employment Dispute: Discrimination 0 Employment Dispute: Other CIVIL APPEALS Administrative Agencies 0 Board of Assessment 0 Board of Elections Dept. of Transportation Statutory Appeal: Other 0 Zoning Board 0 Other: 0 Other: REAL PROPERTY 0 Ejectment 0 Eminent Domain/Condemnation 0 Ground Rent 0 Landlord/Tenant Dispute 0 Mortgage Foreclosure: Residential 0 Mortgage Foreclosure: Commercial 0 Partition 0 Quiet Title 0 Other: IS ELLANEOUS Common Law/Statutory Arbitration eclaratory Judgment Mandamus Non-Domestic Relations Restraining Order 0 Quo Warranto 0 Replevin 0 Other: Updated 1/1/2011 , ,r . Dear Dawn m, millin on 1/12/11 at appoximately 1135 this sgt j.mohn was doing blue exchange on b-block during the exchange co.liddick and sgt mohn was cuessing at me and disrepecting me andmy reaigion. Iwas scared for my life and the sgt j.mohn was disrepecting my reaigion because I'm mulimsgt j.mohn knock my kufi out of my hand and was smile about it. the sgt j.mohn slam me too the floor and my eye hit W the hearting sitament my eye was blooding %sgt n put his foot on my head usind accessive force on head my right eye was bloooding bab blood wasaon the f loor . SINCERELY Douglas.Quran Avery I need to get this suit money for m eye right eye injury than if you can .* help me please thankyou Mrmillin COUNTY OF FOREST OFFICE OF REGISTER, RECORDER, PROTHONOTARY, CLERK OF COURTS DAWN M. MILLIN 526 Elm Street, #2, Tionesta, Pennsylvania 16353 8141755-3526 March 8, 2012 Douglas Avery Quran, Jr. #JU7684 SCI Forest PO Box 945 Marienville PA 16239 Dear Mr. Quran: Enclosed is a copy of the Civil Cover Sheet which is now necessary to file a new Civil Action. No other forms are available in this office. Forest County local rules are available at www.warrenforestcourt.org Sincerely, t??lN Dawn M. Millin Prothontary/Clerk of Courts '_? cam- '?SiL4?? _?T?.-c-?.e«•-3?? ?L -c IL ??? ,?? -- _ 1-5 ?A I IFjXGpR UM IT mpunrfa ?"-'?'8 F L ?LLE?' C??C-?.??`° •?.^_-?.?.G:C?Cr- ?'?_ `?" 'r ?'t ??... y -_? M c_?t - _ „_^-?- c'` ? -???-i_? ?'^?---a?°? `.?-? -?'..`?..-c?'?=-•-c 'mss ?' ? 'ti 3-5 ETC' E`.?`^L`<' n?F ?? ,..:.. -, •_••? C P ?- L ?? f N'?.4.i d /?!/` f?0.'1 ? 4? ?.I??4 i... ? 7J V`. G K ? ` ? -a ` i\N f?t?`1 • 01'? U>?-' :Sir v- c- 1. - -? 1 r ?5 5 l 1 y ter, Cc--)L-) c \ s' aQ C_um)c!?t \AA \C\ Ccot1 AVFRY 'DauGLAS sv?ra ? ?C Z 1:6ces& 'Dk. box ''': ?ACiAtIVI,I,E ? 1laZ3q vA' ?e?a2?-mark o-? ?,oc ce c'? ? of\S SCI - 1?e?en d?a?S, M o? i o O 'Fo! I'\1l o ? A? MP (Or 6} C OUYSP\ Ciu,l Ac?-\c f CASQ- k6 1- 12- - 23"t'l \o \'Nw _ 0? \Aw c oc, my dwc?. z ?c;e?\ o Co????c? C:,v\0?wNtec's N\?- O'os? o? v W cc?\e-- iN. -'c`fl `? l 'Myse4 kcq'nc ?CN r u\ ?n'emNgc WAS \lQC -z- ?? WP \ N1nks f\AoJon rc.5ot\ CA%Q- c??v;c? snve??ga? b? ?? A\t ? `\\ c? c? h2 ?\? ?o coo bec ?\?s? a ? ?n? :rnp?; Sow me.?;?? . --s f j t?o?\d o -? Ps--\ \0?'wjoc" ?o Comoc\ CcosS F XAr?n;r??\;o? ?? ?Acv?e I Law `?????? -? ???? ?, s?\? ?? ??•? ? rrt C-?\?\ )?IN\' fX-\CV:oc-\ o? Cd?nS?\ And Sep c r\e,m ?? ?` - ON , lir ?S Co?nSQ1 ,? ?h;S CASQ , m? ,- ..ll `z C??.C\?c2 vt?C e ?A\\ p ? ?c Luc ?\(?+A \ ??Q -tCv? ? CoccQ? q ? d u 1Rs Anoai DOUGLAS J. AVERY, IN THE COURT OF COMMON PLEAS OF SCI FOREST CUMBERLAND COUNTY, PENNSYLVANIA MARIENVILLE, PA 16239 V. PENNSYLVANIA DEPARTMENT : NO. 2012 - 2339 CIVIL TERM OF CORRECTIONS, SCI CAMP HILL, Defendant ORDER OF COURT AND NOW, this 25TH day of JULY, 2012, the Defendant's request for appointment of counsel in this civil action is DENIED. , 4; e Court / Edward E. Guido, Douglas J. Avery - JU7684 J-A1001 - 1 cell - A-pod SCIFOREST P.O. Box 945 C E _z Marienville, Pa. 16239' rYt cu Ad E rZI C-:l r? _r crr -