HomeMy WebLinkAbout02-0950IN THE COURT OF COMMON PLEAS OF THE JUDICIAL DISTRICT
OF PENNSYLVANIA COUNTY CUMBERLAND
JEFFREY WAYNE HORN § CIVIL ACTION- LAW
Plaintiff § _t?~_ .q~t~ ~t. oc L
vs. § CASE NO.
DAWN RENEE HORN §
Defendant § IN DIVORCE
TERM
NOTICE TO DEFEND AND CLAIM RIGHTS
You have been sued in court for:
[] Divorce
[] Support
[] Division of Property
[] Temporary Alimony
[] Costs
[] Annulment of Marriage
[] Custody and visitation
[] Alimony
[] Attorney
You have been sued in Court. If you wish to defend against the claims set forth on the
other side of this page, you must take prompt action. You are warned that if you fail to do so, the
case may proceed without you and a decree of divorce or annulment may be entered against you
by the court. A judgment may also be entered against you for any other claim or relief requested
in this paper by the Plaintiff. You may lose money or property or other rights important to you,
including custody or visitation of you child or children.
When the ground for divorce is indignities or irretrievable breakdown of the marriage,
you may request marriage counseling. A list of marriage counselors is available in the Office of
the Prothonotary at the CUMBERLAND county Courthouse, in , PA.
IF YOU DO NOT FILE A CLAIM FOR ALIMONY, DIVISION OF PROPERTY,
LAWYER'S FEES OR EXPENSES BEFORE DIVORCE OF ANNULMENT IS GRANTED,
YOU MAY LOSE THE RIGHT TO CLAIM ANY OF THEM.
YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO
NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE
OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP.
Office of the Prothonotary
CUMBERLAND County Courthouse
, PA.
Telephone( )
ADVERTENCIA SOBRE COMO DEFENDERSE Y RECLAMAR DERECHOS
Usted ha sido demandado en corta para
[] Divorcio
[] Pension Alimenticia
(Mantenimiento)
[] Division de Propiedad
[] Costos
[] Annulacion de Matrimonio
[] Custodia y Visitacion
[] Pension Alimenticia Temporana
[] Costos de Abogado
Usted ha sido demandado en corte. Is usted desea defender el reclamo puesto en contra suya en
las siguientes paginas, tiene que tomar accion immediamente. Se le advierte que si falla de
hacerlo, el caso puede ser procesado sin su de usted por la corte. Un juicio tambien puede ser
registrado en su contra por cualquier por reclaimo o peticion requerida en estos papeles por el
querellante. Usted puede perder dinero, propiedad o otros derechos importantes para usted,
incluyendo custodia o visitacion para sus ninos.
Cuando la causa del divorcio es maltrato o trastomo irrearable en el matrimonio, usted debe
solicitar consejeria matrumonial. Una lista de consejeros matrimoniales esta disponible en las
oficinas del protonotario en Cuarto de la PA Room __
SI USTED NO REGISTRA UN RECLAMADO PARA LA PENCION ALMENTICIA, LA
REPARTICION DE PEOPIEDADES, EL HONORARIO DEL ABOGADO O GASTOS ANTES
DE QUE EL UN DIVORCIO O ANNULACION SEA OTORGADO, USTED PUEDE PERDER
EL DERECHO DE RECLAMAR CULAQUIERA DE ESTOS.
USTED DEBE LLEVAR ESTE PAPEL A SU ABOGADO IMMEDIAMENTE. SI USTED NO
TIENE UN ABOGADO O NO PUEDE PAGAR POR LOS SERCICIOS DE UNO. VAYA O
LLAME A LA OFIC1NA INDICADA, PARA AVER DONDE PUEDE OBTENER
ASISTENCIA LEGAL.
SERVICIO DE REFERENCIA DE ABOGADO
IN THE COURT OF COMMON PLEAS OF THE JUDICIAL DISTRICT
OF PENNSYLVANIA COUNTY CUMBERLAND
JEFFREY WAYNE HORN
Plaintiff
DAWN RENEE HORN
Defendant
§ CIVIL ACTIOI~ - LAW
§ CASE NO.
§ 1N DIVORCE
COMPLAINT UNDER SECTION 3301 (c) OR 3301 (d) OF THE DIVORCE CODE
1. Plaintiff is JEFFREY WAYNE HORN who resides at; 340 Fox Hollow Rd. #18; Shermans
Dale, Pennsylvania 17090.
2. Defendant is DAWN RENEE HORN who resides at: 500 Highland Ct.; Carlisle,
Pennsylvania 17013.
3. [] Plaintiff and/or [] Defendant have been a bona fide resident(s) of the Commonwealth of
Pennsylvania for at least six months immediately prior to commencement of this action.
4. Plaintiff married Defendant on October 26, 1985 at Ebensburg, Pennsylvania. Attached hereto
and marked as Exhibit "A" is the certificate of marriage evidencing said marriage.
5. Neither plaintiff nor defendant is in the military or naval service of the Unites States or its
allies within the provisions of the Soldier's and Sailor's Civil Relief Act of Congress 1940 and
its amendments.
6. There has been no prior action of divorce or for annulment between the parties.
7.The marriage is irretrievably broken.
8. After 90 days have elapsed from the date of filing of this Complaint, Plaintiff intends to file an
affidavit consenting to a divorce. Plaintiff believes that Defendant may also file such an affidavit.
Complaint for Divorce; Page 1
9. Plaintiff has been advised that marriage counseling is available and that Plaimiff may have the
right to request that the Court require the parties to participate in marriage counseling.
10. The following children were bom to or adopted by the parties to this marriage:
Name
SHANE ANTHONY HORN
KRISTEN JEAN HORN
Birthdate Age
June 18, 1986 I~'~ears
November 30, 1988 ~ years
WHEREFORE, if both parties file affidavits consenting to a divorce after 90 days have
elapsed form the date of filing of this Complaint, Plaintiff respectfully requests that a decree of
divorce be entered pursuant to Section 3301(c) of the Divorce Code dissolving the marriage
between the Plaintiff and Defendant.
COUNT II
REQUEST FOR INCORPORATION OF MARITAL SETTLEMENT AGREEMENT
PURSUANT TO SECTIONS 3104(A)(1) AND (3) AND 3323(B) OF THE DIVORCE CODE.
11. Paragraphs 1-10 are incorporated herein and made a part hereof by reference as though fully
set forth.
The parties have entered into a written Marital Settlement Agreement providing for the care,
custody and support of their minor child(ren), a copy of which is attached hereto and
incorporated by this reference the same as if fully set forth at length, and their agreement is in
the best interest of the child(ren).
WHEREFORE, Plaintiff respectfully requests that this Court approve and incorporate the
agreement reached between the parties into the final divorce decree, pursuant to Sections
3104(a)(1) and (3) and 3323(b) of the Divorce Code.
Complaint for Divorce; Page 2
~.~3~RF~'A"~NE HORN
I verify that the statements made in this Complaint are true and correct. I understand that
false statements herein are made subject to penalties of the 18 Pa.C.S. Section 4904 relating to
unswom falsification to authorities.
J~_)I~Y ~Y~ ~-IORN, Pro Per
Complaint for Divorce; Page 3
NOTICE TO DEFEND AND CLAIM RIGHTS
You have been sued in Court. If you wish to defend against the claims set forth on the
other side of this page, you must take prompt action. You are warned that if you fail to do so, the
case may proceed without you and a decree of divorce or annulment may be entered against you
by the court. A judgment may also be entered against you for any other claim or relief requested
in this paper by the Plaintiff. You may lose money or property or other rights important to you,
including custody or visitation of you child or children.
When the ground for divorce is indignities or irretrievable breakdown of the marriage,
you may request marriage counseling. A list of marriage counselors~is ,available in the Office of
the Prothonotary at the CUMBERLAND county Courthouse, in (. av~.¥,?~\ 6 , PA.
IF YOU DO NOT FILE A CLAIM FOR ALIMONY, DIVISION OF PROPERTY,
LAWYER'S FEES OR EXPENSES BEFORE DIVORCE OF ANNULMENT IS GRANTED,
YOU MAY LOSE THE .RIGHT TO CLAIM ANY OF THEM.
YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO
NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE
OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP.
Office of the Prothonotary
CUMBERLA~D~County Courthouse
C /,4t ,PA.
Telephone( "1 [-/. )
READ OTHER SIDE
Complaint for Divorce; Page 4
IN THE COURT OF COMMON PLEAS OF THE JUDICIAL DISTRICT
OF PENNSYLVANIA COUNTY CUMBERLAND
JEFFREY WAYNE HORN
Plaimiff
DAWN RENEE HORN
Defendant
§ CIVIL ACTION - LAW
§ a~-~'~ C,~, 1
§ CASE NO.
§ 1N DIVORCE
TEILM
ACCEPTANCE OF SERVICE
I hereby accept service of the Complaint in Divorce filed in the above-captioned matter.
IN THE COURT OF COMMON PLEAS OF THE JUDICIAL DISTRICT
OF PENNSYLVANIA COUNTY CUMBERLAND
JEFFREY WAYNE HORN §
Plaintiff §
VS. §
DAWN RENEE HORN §
Defendant §
CIVIL ACTION
CASE NO.
IN DIVORCE
AFFIDAVIT OF CONSENT
1. A Complaint in Divorce under Section 3301 (c) of the Divorce Code was filed on the&~o day
of .~.f ~'~,qa¥ , ;~c~k,
2. The marriage between the parties hereto is irretrievably broken. Ninety days have elapsed
since the filing of the Complaint.
2. I am aware that marriage counseling is available and do not desire said counseling.
3. I state that I have read copies of the Complaint for Divorce Under Section 3301(c) of the
Divorce Code, and I understand said Complaint. I waive any pleading periods and notices there
may be.
4. I hereby enter my consent to the entry of a final decree of divorce.
5. 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.
6. 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
unswom falsification to authorities.
Dated:
JEFFP~A~Ho'~N, Pla~ntiff
IN THE COURT OF COMMON PLEAS OF THE JUDICIAL DISTRICT
OF PENNSYLVANIA COUNTY CUMBERLAND
JEFFREY WAYNE HORN §
Plaintiff §
VS. §
DAWN RENEE HORN §
Defendant §
CIVIL ACTION - LAW
IN DWORCE
AFFIDAVIT OF CONSENT
1. AjC°mplaint in Divorce under Section 3301 (c) of the Divorce Code was filed on the ~ day
of V s. q5 '
2. The marriage between the parties hereto is irretrievably broken. Ninety days have elapsed
since the filing of the Complaint.
2. I am aware that marriage counseling is available and do not desire said counseling.
3. I state that I have read copies of the Complaint for Divorce Under Section 3301(c) of the
Divorce Code, and I understand said Complaint. I waive any pleading periods and notices there
may be.
4. I hereby enter my consent to the entry of a final decree of divorce.
5. 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.
6. I verify that the statements made in this affidavit are tree and correct. I understand that false
statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to
unswom falsification to authorities.
DAX~N RENEE ~O'~RN, Def~n~lant
IN THE COURT OF COMMON PLEAS OF THE JUDICIAL DISTRICT
OF PENNSYLVANIA COUNTY CUMBERLAND
JEFFREY WAYNE HORN § CIVIL ACTION - LAW
Plaintiff §
vs. § CASE NO. 6h_~- q~'C)
DAWN RENEE HORN §
Defendant § IN DIVORCE
MARITAL SETTLEMENT AGREEMENT
THIS AGREEMENT made and entered into this the ~3 day of ~r,,ff, ~ , &~t>'z
between JEFFREY WAYNE HORN residing at 340 Fox Hollow Rd. #18; Shermans Dale,
Pennsylvania 17090 and DAWN RENEE HORN who resides at 500 Highland Ct.; Carlisle,
Pennsylvania 17013.
WHEREAS we were married to each other at Ebensburg, Pennsylvania on October 26,
1985 and lived as husband and wife until such time as we separated on May 31, 1993; and
WHEREAS a permanent breakdown of the marriage has arisen between us and we are
now living separate and apart from each other; and
WHEREAS there are no unmarried children under the age of eighteen years bom to or
adopted by the parties and none is expected.
WHEREAS we now intend, by this agreement, to make a final and complete settlement
of all of our rights and obligations concerning spousal support, division of property and debts, the
care, custody, control, access to and support of our minor children; and
WHEREAS the parties hereto warrant and declare under penalty of perjury that the assets
and liabilities divided in this agreement constitute all their marital assets and liabilities, and
further that in the event that the division of their assets and debts is unequal, the parties do hereby
declare that they knowingly and intelligently waive an equal division of their marital estate; and
WHEREAS in consideration of the premises and mutual promises and undertakings
herein contained, and for other good and valuable consideration, the parties agree to the
following:
I. THE PARTIES AGREE to live separate and apart from the other party, free from any
control, restraint or interference, direct or indirect by the other party, and in all respects to live as
if he or she were sole and unmarried.
Il. DIVISION OF PROPERTY: We agree to divide the property of our marital estate as
follows:
1. DAWN RENEE HORN Transfers to JEFFREY WAYNE HORN as sole and
separate property and DAW2N RENEE HORN is divested of all right, title, and interest in
and to the following property_:
Household Furniture, etc. All household furniture, furnishings, fixtures, goods,
appliances, and equipment in the possession of or subject to the sole control of
JEFFREY WAYNE HORN.
Clothing, etc. All clothing, jewelry, and other personal effects in the possession
of or subject to the sole control of JEFFREY WAYNE HORN.
Cash. All cash in the possession of or subject to the sole control of JEFFREY
WAYNE HORN.
Checking Accounts. All checking accounts at all banks or other financial
institutions which stand in JEFFREY WAYNE HORN's sole name or from which
JEFFREY WAYNE HORN has the sole right to withdraw funds.
Credit Union Accounts. All credit union accounts at all credit unions which
stand in the sole name of JEFFREY WAYNE HORN or from which JEFFREY
WAYNE HORN has the sole right to withdraw funds:
Certificates of Deposit. All certificates of deposit at all banks or other financial
institutions which stand in the sole name of JEFFREY WAYNE HORN or from
which JEFFREY WAYNE HORN has the sole right to withdraw funds.
Life Insurance. All policies of life insurance insuring the life of JEFFREY
WAYNE HORN.
Employment Benefits. All sums and all rights related to any profit sharing plan,
retirement plan, pension plan, or like benefit program existing by reason of
JEFFREY WAYNE HORN's past, present, or future employment and not
otherwise awarded to DAWN RENEE HORN in this agreement.
2. JEFFREY WAYNE HORN Transfers to DAWN RENEE HORN as sole and
separate property, and JEFFREY WAYNE HORN is divested of all right, title, and interest
in and to the following property:
Household Furniture, etc. All household furniture, furnishings, fixtures, goods,
appliances, and equipment in the possession of or subject to the control of DAWN
RENEE HORN.
Clothing, etc. All clothing, jewelry, and other personal effects in the possession
of or subject to the control of DAWN RENEE HORN.
Cash. All cash in the possession of or subject to the sole control of DAWN
RENEE HORN.
Checking Accounts. All checking accounts at all banks or other financial
institutions which stand in the sole name of DAWN RENEE HORN or from
which DAWN RENEE HORN has the sole right to withdraw funds.
Credit Union Accounts. All credit union accounts at all credit unions which
stand in the sole name of DAWN RENEE HORN or from which DAWN RENEE
HORN has the sole right to withdraw funds:
Certificates of Deposit. All certificates of deposit at all banks or other financial
institutions which stand in the sole name of DAWN RENEE HORN or from
which DAWN RENEE HORN has the sole right to withdraw funds.
Life Insurance. All policies of life insurance insuring the life of DAWN RENEE
HORN.
Employment Benefits. All sums and all rights related to any profit sharing plan,
retirement plan, pension plan, or like benefit program existing by reason of
DAWN RENEE HORN's past, present, or future employment and not otherwise
awarded to JEFFREY WAYNE HORN in this agreement.
DEBTS TO BE PAID BY JEFFREY WAYNE HORN
JEFFREY WAYNE HORN shall pay, as a part of the division of the estate of the parties,
the following and shall indemnify and hold DAWN RENEE HORN and DAWN RENEE
HORN's property harmless from any failure to so discharge these items:
Any and all debts, charges, liabilities, and other obligations incurred solely by JEFFREY
WAYNE HORN from and after May 31, 1993 unless express provision is made in this
decree to the contrary.
All debt associated with any property awarded to JEFFREY WAYNE HORN.
DEBTS TO BE PAID BY DAWN RENEE HORN:
DAWN RENEE HORN shall pay, as a part of the division of the estate of the parties, the
following and shall indemnify and hold JEFFREY WAYNE HORN and JEFFREY WAYNE
HORN's property harmless from any failure to so discharge these items:
Any and all debts, charges, liabilities, and other obligations incurred solely by DAWN
RENEE HORN from and after May 31, 1993 unless express provision is made in this
decree to the contrary.
All debt associated with any property awarded to DAWN RENEE HORN.
III. NOTICE
Each party shall send to the other party, within three days of its receipt, a copy of any
correspondence from creditor or taxing authority concerning any potential liability of the other
party.
IV. ALIMONY - MAINTENANCE:
Both parties agree to waive any rights or claims that either may now have or in the future
to receive alimony, maintenance, or spousal support from each other. Both parties understand the
full import of this provision.
V. NECESSARY DOCUMENTS:
THE PARTIES AGREE TO EXECUTE AND DELIVER TO the other party any documents that
may be reasonably required to accomplish the intention of this instrument and shall do all other
necessary things to this end.
VI. PARENTING PLAN:
[] JOINT LEGAL CUSTODY WITH PRIMARY PHYSICAL CUSTODY:
Husband and Wife shall each share jointly the legal custody and care of our minor
children with
[] Wife [] Husband to have the primary physical custody of the children. Our
parenting relationship shall be guided by the following terms and conditions:
[] SOLE LEGAL AND PHYSICAL CUSTODY: [] Wife [] Husband shall have sole
legal and physical custody of the child(ren). Our parenting relationship shall be guided
by the following terms and conditions:
Both parents shall have all the rights and duties of a parent at all times, including:
the right to receive information from the other parent concerning the health, education and
welfare of the child(ren); to confer with the other parent to the extent possible before making
decisions concerning the health, education and welfare of the child(ren); of access to medical,
dental, psychological and educational records of the child(ren); to consult with a physician,
dentist or psychologist of the child(ren); the fight to consult with school officials concerning the
child(ren)'s welfare and educational status, including school activities; the right to attend school
activities; the right to be designated on any records as a person to be notified in case of an
emergency; and the fight to manage the estate of the child to the extent the estate has been
created by the parent or the parent's family.
Both Parents shall confer with each other on all important matters concerning the
health, education and welfare of the children. If matters arise that they are unable to agree
upon, the issue shall be submitted to a professional for dispute resolution or arbitration.
Both will encourage a positive relationship between the children and the other
parent.
Both Parents shall sh~re jointly the fo!lowing rights~ duties, privileges, and powers
at all times; including; to direct thc moral and religious training of the child(ten) during periods
of possession; thc duty of care, control, protection and reasonable discipline of thc child(ten),
including providing the child(ten) with clothing, food, shelter, and medical and dental care not
involving an invasivc procedure; and the power to consent to medical, dental and surgical
treatment during an emergency involving an immediate danger to the health and safety of the
child(ren).
*** [] Wife [] Husband shall be tbo~ primary custodial parent and shall h~ve sole right to
establish the primary residence of the children, and further shall have thc following exclusive
rights and duties to: the power to consent to the marriage, to medical, dental, and surgical
treatment involving invasivc procedures, and to psychiatric and psychological treatment; thc
power to represent thc child(ten) in legal action and make other decisions of substantial legal
significance concerning thc child(ten), except when a guardian of thc child's estate or a guardian
or attomey ad litem has been appointed for the child(ren), a power as an agent of the child(ren) to
act in relations to the child's estate if the child(ren)'s action is required by a state, the United
States, or a foreign government.
[] Neither parent shall conceal a child's whereabouts from the other parent nor remove a
child from the state for more than __ days without prior written consent of the other parent.
[] The residence of the children shall remain in __ County, State of until
further order of the court.
[] The children will keep the father's surname and not take on the Mother's maiden name
or the name of any new spouse, at least until the child is eighteen years of age and is old
enough to make that decision for themselves.
[] The following grandparent(s), shall succeed the non-custodial parent in their rights of
visitation and temporary possession of the children in the event the non-custodial parent dies
before each child is eighteen years of age:
[] For any child under the age of three years, the terms of the attached Schedule for the
Possession of Minor Children shall take effect on that child's third birthday, and until such time,
the schedule shall be at the specific times and places set forth in the attached Schedule for
Possession of Children Under the Age of Three Years which is incorporated herein for all
purposes by this reference.
[] Wife [] Husband, as the non-custodial parent shall have the right to physical
possession of the children, AT ALL TIMES MUTUALLY AGREED upon by the
parties and failing agreement, at such specific times and places as are set forth in the
attached Schedule for Possession of' Minor Children which is incorporated herein for all
purposes by this reference.
The non-custodial parent shall not interfere with the Custody of the child(ren) and shall
return the child(ren) to the care of the primary custodial parent immediately upon the
termination of each period of possession to which the non-custodial parent is entitled
under the terms of this agreement.
primary custodial parent shall surrender the child(ren) to the non-custodial parent at the
beginning of each period of possession.
AGREED CHILD SUPPORT: The basis of the agreed support for the benefit of our children
established by this agreement is based on the following facts;
We make this agreement freely without coercion, threat or duress. We declare that
this agreement is in the best interest of our child(ren) and that the needs of the children will
be adequately met by the agreed amount. We are fully informed of our rights concerning
child support and of the guidelines for establishing child support put forth by the state and
presumed to be in the best interest of the child(ren).
The right to support has not been assigned to the office of the Attorney general in
consideration for the receipt of payments from the state for the support of the children and no
public assistance application is pending.
As for child support:
[] The parties are capable of supporting their minor child(ren) and neither parent shall pay
child support to the other parent.
[] The non-custodial parent, hereinafter Obligor shall pay to the primary custodial parent,
hereinafter Obligee, a total of $ per month, payable in advance on
the 1 st day of month immediately following the rendition of this agreement between and
among the parties and a like amount being due and payable on the same day of each
subsequent month thereafter continuing until the earliest of any of the following
conditions occur for any child subject of this suit: the child reaches the age of 18 years
and thereafter do long as the child is fully enrolled in an accredited primary or secondary
school in a program leading toward a high school diploma, until the end of the school
term in which the child graduates; the child marries; the child's disabilities are otherwise
removed for general purposes; the child is otherwise emancipated; the child dies; or
further agreement and order of the court.
[] Thereafter, the Obligor shall pay to Obligee child support of $ per
month, with the first payment being due and payable on the first day of each month until the first
month following the date of the next occurrence of one of the events specified above.
Obligor's obligation to support the child(ren) shall not terminate upon Obligor's death
but shall continue as a debt of Obligor's estate.
The child support obligation shall terminate upon the death of the custodial parent
receiving child support provided the payor assumes full custody of the children, otherwise, the
child support obligation shall continue being paid to the third party assuming primary custody
and child rearing responsibilities for the children as successor to the primary custodial parent.
[] MEDICAL HEALTH INSURANCE: JEFFREY WAYNE HORN shall carry and
maintain medical health insurance for the benefit of said child(ren). The reasonable health
care costs not covered by any policy of health insurance shall be paid as follows; Obligor
shall pay __% and Obligee shall pay __ %.
[] CHILD CARE: As additional child support, Obligor, shall pay to Obligee a total of
$ per month, payable in advance on the 1 st day of each month, commencing on
the first day in the month immediately following the parties rendition of this agreement
and continuing as long as child care is necessary and actually being paid.
[] LIFE INSURANCE: To ensure the availability of funds to support the parties' minor
children in the event of either parent's death, both parties agree to carry and maintain a
policy of life insurance in the amount of $ , and shall name as sole
irrevocable beneficiaries the surviving parent who shall assume full custody of the
children upon the death of the other parent, with said insurance proceeds to be used to
ensure the support of the child(ren).
[] DEPENDENT CHILD EXEMPTION: [] Wife [] Husband, shall have the right to
claim the dependency exemption for the child(ren).
VII. AGREEMENT DESIGNED TO FACILITATE A DIVORCE OR DISSOLUTION OF
THE PARTIES' MARRIAGE:
This Agreement is entered into with the express intent to facilitate encourage, aid, and in
any other manner lead to a divorce and or dissolution of the marriage between the parties
hereto.
VIII. SUBSEQUENT DISSOLUTION OF MARRIAGE:
Respondent/Defendant herein, acknowledges receipt of a copy of the documents to be filed
herein with this agreement of the parties attached as Exhibit "A", and states that he/she has read
and understands the same. It is agreed that this Agreement shall be offered into evidence by
either party in any dissolution of marriage proceeding, and if acceptable to the Court, this
Agreement shall be incorporated by reference in any Final Judgment that may be rendered, and
the parties shall be ordered to comply with all its provisions, and all warranties and remedies
provided in this agreement shall be preserved. However, notwithstanding incorporation in the
Final Judgment, this Agreement shall not be merged in but shall survive the Final Judgement and
be binding on the parties for all times.
IX. REPRESENTATION:
The parties represent to each other:
(a) Each had the right to independent counsel. Each party fully understands their legal rights and
each is signing this Agreement f~eely and voluntarily, intending to be bound by it.
(b) Each has made a full disclosure to the other of his or her current financial condition.
(c) Each understands and agrees that this Agreement is intended to be the full and entire contract
of the parties.
(d) Each agrees that this Agreement and each provision of it is expressly made binding upon the
heirs, assigns, executors, administrators, successors in interest and representatives of each party.
X. WAIVER OF BREACH:
No waiver of any breach by any party of the terms of this Agreement shall be deemed a waiver of
any subsequent breach.
XI. ENFORCEMENT OF THE AGREEMENT:
Both parties agree that the Court granting the divorce, at the request of either party, insert in the
Final Judgment a reservation of jurisdiction for the purpose of compelling either party to perform
this Agreement, or any part thereof. The prevailing party shall be entitled to attorney's fees in
connection with such proceeding.
XII. GOVERNING LAW:
This Agreement shall be interpreted and governed by the laws of the state of.
XIII. WAIVER OF SERVICE OF PROCESS AND FILING AN ANSWER:
Respondent/Defendant herein, acknowledges receipt of a copy of the documents to be filed herein, and
states that he/she has read and understands the same, hereby waives the issuance, service, and remm of
process upon him/her in this action enters a voluntary appearance in this cause, waiving all time and right
to plead, answer or appear in this action, and consents that the same may be set down for trial and heard
by the court at any time hereafter without notice to, and in the absence of, this Respondent/Defendant.
XIV. WAIVER OF EMPLOYEE AND/OR MILITARY RETAINER OR RETIREMENT
BENEFITS:
Both parties agree to waive any fights, interests, or claims, that either may now have or in the
future to receive employee and/or military retainer or retirement benefits resulting from the past, present
or future employment and/or service of the other party in the Armed Forces of the United States. Both
parties understand the full import of this provision.
STATE OF Pennsylvania §
COUNTY OF Perry §ss.
DAWN RI~N~I~HORN~ P~esponde'nt/Defendant
Before me, the undersigned, a Notary Public, on this __ day of , _, personally
appeared the above named Respondent/Defendant to me known to be the identical person who executed
the above and foregoing Marital Settlement Agreement and personally acknowledged to me that he/she
read, understood and signed the same; and that he/she executed the same as his/her free and voluntary act
and deed for the uses and purposes therein set forth.
IN WITNESS WHEREOF, I have hereunto affixed my signature and official seal the day and date
heretofore stated.
My commission expires:
Notary Public
SIGNED ON THIS THE ~ day of
STATE OF Pennsylvania §
COUNTY OF Cumberland §ss.
Before me, the undersigned, a Notary Public on this ___
JEFFREY ~N~ H{~I~, l~tioner/Plaintiff
day of ., _, personally
appeared the above named Petitioner/Plaintiff to me known to be the identical person who executed the
above and foregoing Marital Settlement Agreemem and personally acknowledged to me that he/she read,
understood and signed the same; and that he/she executed the same as his/her free and voluntary act and
deed for the uses and purposes therein set forth.
IN WITNESS WHEREOF, I have hereunto affixed my signature and official seal the day and date
heretofore stated.
My commission expires:
Notary Public
IN THE COURT OF COMMON PLEAS OF THE ~ JUDICIAL DISTRICT
OF PENNSYLVANIA COUNTY CUMBERLAND
JEFFREY WAYNE HORN Plaintiff
VSo
DAWN RENEE HORN
Defendant
CIVIL ACTION - LAW
CASE NO. 0~- q'50 ("; O, ~
IN DIVORCE
PRAECIPE TO TRANSMIT RECORD
To the Prothonotary:
Transmit the record, together with the following information, the Court for entry of a
divorce decree:
Dated:
1. Ground for divorce: Irretrievable breakdown under Section 3301 (c) of the Divorce
Code.
2. Date and manner of service of Complaint: the '~-/day of JF-~C-ho ['c.C. ,
by Acceptance of Service
o
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: ~r>~', \ ~'3 , o)?t~_ By Defendant: ~13¢', \
(b)(1) Date of execution of the Plaintiffs affidavit required by'Section ~01(d) of the
Divorce Code:
4. Related claims pending:
(a) Related Claims Pending: Incorporation of attached agreement.
(b) Claims withdrawn
(c) Claims settled by agreement of the parties: Division of property, custody,
visitation, child support.
(d) State whether any written agreement is to be incorporated into the Divorce Decree.
If yes, attach a true and correct copy of the fully executed agreement to the proposed
Decree that is submitted herewith: YES.
5. I certify that the Notice of Intent to File Praecipe to Transmit as required by Rule
1920.42(c) or (d) was mailed on (~mrZ,\ /~ , ~t>t~,~ and a copy
thereof is attached. I further certify thht all other documents required by Rule 1920.42(e)
are enclosed herewith.
~ J~FR~ ;~YNE HORN
iN THE COURT OF COMMON
Of CUMBERLAND COUNTY
STATE OF ~~ PENNA.
versus
PLEAS
AND NOW,~
DECREED THAT
AND
DECREE IN
DIVORCE
,~~, IT IS ORDERED AND
_, PLAINTIFF,
, DEFENDANT,
ARE DIVORCED FROM THE BONDS OF MATRIMONY.
ThE COUrt RETAINS JUriSDICTION OF ThE FOLLOWING CLAimS WHICH HAVE
BEEN RAISED OF RECORD IN THIS ACTION FOR WHICH A FINAL ORDER HAS NOT
YEt BeEN ENTERED~OI~~-
BY
ATT :ST: j.
RY