HomeMy WebLinkAbout12-3465??G?1?'?y??/NliL?
IN THE COURT OF COMMON PLEAS OF
Plaintiff
CUMBERLAND COUNTY, PENNSYLVANIA
V,
?'?? ?^? J lob -3 SIVV I V I L 78EA4 s4
NO. CIVIL TERM
Defendant M m ' T.
cn . „ w
PETITION TO PROCEED IN FORMA PAUPERISE _ D
77,
C' _
The Petitioner, the above-captioned matter respectfully
petitions this Court for permission to proceed in forma pauperis. As set forth in the attached Affidavit,
which is incorporated herein by reference, Petitioner is unable to pay the fees and costs necessary to
commence these proceedings.
WHEREFORE, Petitioner requests that this Court enter an order permitting her to proceed in
forma pauperis.
'?- j I---
Date
,Petitioner
C-7/ J?
?y
Plaintiff
V.
J kt -0 V- 1? J
Defendants
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
NO. CIVIL TERM
AFFIDAVIT IN SUPPORT OF PETITION
TO PROCEED IN FORMA PAUPERIS
1. I am the Defendant in the above matter and because of my financial condition am unable to
pay the fees and costs of prosecuting, defending, or appealing the action or proceeding.
2. I am unable to obtain funds from anyone, including my family and 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:
?r -2-
(b) Address: /'
h??Pw / Z e
If you are presently employed, state
rcln
Employer:
Address:
Salary or wages per month: ??
Type of work:
If you are presently unemployed, state
Date of last employment:
Salary or wages per month:
Type of work:
(c) Other income within the past twelve months
Business or profession:
Other self-employment:
Interest:
Dividends:
Pension and annuities:
Social Security benefits:
Support payments:
Disability payments:-`6 G/
Unemployment compensation and
supplemental benefits:
Workman's compensation:
Public Assistance: e -,5v
Other:
(d) Other contributions to household support
(Wife)(Husband) Name:
If your (husband) (wife) is employed, state
Employer:
Salary or wages per month:
C
Type of work:
Contributions from children:
(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:
Monthly Expenses: `'
(g) Persons dependent upon you for support
(Wife) (Husband) Name:
Children, if any:
Name: Age:
4. 1 understand that I have a continuing obligation to inform the court of improvement in my
false statements herem are ma a su ?e p
falsification to authorities.
financial circumstances, which would permit me to pay the costs incurred herein.
5. verify that the statements made in this affidavit are true and correct. I understand that
d b' ct to the enalties of 18 Pa. C.S. 4904, relating to unsworn
Date:
COMMONWEALTH OF PENNSYLVANIA
COURT OF COMMON PLEAS NOTICE OF APPEAL
Judicial District, County Of FROM
DISTRICT JUSTICE JUDGMENT
COMMON PLEAS No. la, 3q&5 OivdTerm
NOTICE OF APPEAL
Notice is given that the appellant has filed in the above Court of Common Pleas an appeal from the judgment rendered by the District Justice on
the date and in the case referenced below.
v. _ J-) h .i P5 Q.U
rriJ ?= 0 C%,,- ? - CV?o p / o o ? o'er 1 -?'t
This block will be signed ONLY when this notation is required under Pa.
R.C.P.D.J. No. 10088.
This Notice of Appeal, when received by the District Justice, will operate as a
SUPERSEDEAS to the judgment for possession in this case.
(see Pa. R.C.P.D.J. No.
before a District Justice, A COMPLAINT MUST BE FILED within twenty
(20) days after filing the NOTICE of APPEAL.
SOW- d PYWh&--y - Dap*
PRAECIPE TO ENTER RULE TO FILE COMPLAINT AND RULE TO FILE
(This section of fount to be used ONLY when appellant was DEFENDANT (see Pa.R.C.P.D.J. No. 1001(7) in action before District Justice. IF
NOT USED, detach from copy of notice of appeal to be served upon appellee.
PRAECIPE: To Prothonotary
Enter rule upon
Name of appWee(s)
appellee(s), to file a complaint in this appeal
(Common Pleas No. ) within twenty (20) days after service of rule or suffer entry of judgment of non pros.
signature of appellant or aMwney or agent
RULE: To
Name of
, appellee(s)
(1) You are notified that a rule is hereby entered upon you to file a complaint in this appeal within twenty (20) days after the date of service
of this rule upon you by personal service or by certified or registered mail.
(2) If you do not file a complaint within this time, a JUDGMENT OF NON PROS MAY BE ENTERED AGAINST YOU.
(3) The date of service of this rule if service was by mail is the date of the mailing.
Date: 20
Signature of Prothonotary or Deputy
YOU MUST INCLUDE A COPY OF THE NOTICE OF JUDGMENTI TRANSCRIPT FORM WITH THIS NOTICE OF APPEAL.
AOPC 312-02
WHITE -COURT FILE TO BE FILED WITH PROTHONOTARY GREEN - COURT FILE YELLOW - APPELLANTS COPY
PINK -COPY TO BE SERVED ON APPELLEE GOLD -COPY TO BE SERVED ON DISTRICT JUSTICE
-N BENDEF OQ -C' FAX No. 111 323308 P. 003
COMMONWEALTH OF PENNSYLVANIA Notice of Judgment/Transcript Civil
COUNTY OF CUMBERLAND Case
Meg. Dist. No: MDJ-0"-01
MDJ Name; Honorable H. Anthony Adams
Address: 35 West Orange Street
Shippensburg, PA 17257
717.532.7676
Richard Lynch
V.
John Baum
File Copy Docket No. MJ-09301 -CV-00001 00-2012
Case Filed 4113/2012
515}76iiti6n Summary
MJ-09301-CV-0=100-2012 WOArd Lynch John Haunt Judgment for Defendant 08!10/2012
ANY PARTY HAS THE RIGHT TO APPEAL WITHIN 30 DAYS AFTER THE ENTRY OF JUDGMENT BY FILING A NOTICE OF APPEAL WITH
THE PROTHONOTARYICLERK OF COURT OF COMMON PLEAS, CIVIL DIVISION. YOU MUST INCLUDE A COPY OF THIS N011CU OF
JUDGMENTRRANIBCRIPT FORM WITH YOUR NOTICE OF APPEAL.
EXCEPT AS OTHERWISE PROVIDED IN THE RULES OF CIVIL PROCEDURE FOR MAGISTERIAL DISTRICT JUDGES, IF THE JUDGMENT
HOLM NLFCT$ TO 9NTRR THE JUDGMENT IN THE COURT OF commON PLEAS. ALL FURTHER PROCESS MUST COME FROM THE
COURT OF COMMON PLM AND NO FURTHER PROCESS MAY BE ISSUED BY THE MAGISTMIAL DISTEi1CT JUDGE.
UNLESS THE JUDGMENT IS ENTERED IN THE COURT OF COMMON PLEAS, ANYONE INTERESTED IN THE JUDGMENT MAY PILE A
REQUEST FOR ENTRY OF SATISFACTION WITH THE MAGISTERIAL DISTRICT JUDGE IF THE JUDGMENT DEBTOR PAYS IN FULL, SETTLES,
OR OTHERWISE COMPLIES WITH THE JUDGMENT.
Date Magisterial District Judge R Anthony AdS MS
certify a true a corre copy rsca the pro ngs owftlnlng the judgment.
Date Magisterial Diatrict Judge
MDJS 315 Page 1 of 2 Printed: Oal10/201210:47:20AM
l
Plaintiff
V.
Defendants
: IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
NO. CIVIL TERM
/a --A.S 09VI CreRA
ORDER'OF COURT
AND NOW this _ day of _ , 2012, upon consideration of the
attached Petition and Affidavit, the petitioner is allowed to proceed in forma pauperis.
BY THE COURT,
Judge
Distribution
• ? Plaintiff: C,
Nam
VIA& ?dress
Defendant: J &'?A p r j r
ame
77U6
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cz,
COPY