HomeMy WebLinkAbout08-06-14 (2) n -_-"" �z:a�
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PE�YLVA f,A :�=��
CIVIL ACTION - LAW �,�"� �' ``' �
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In re: SUZANNE JOSAPHINE NESTLER, : ��� � � T�
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A minor child : No.��-��•�1�� ��; .• '�n p
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Petition for Waiver of Costs
1. I am the Petitioner in the above matter and because of my financial condition, I am unable
to pay the fees and costs of prosecuting or defending this action or proceeding.
2. I am unable to obtain funds from anyone, including my family and associates, to pay the
costs of litigation. I represent that the information below relating to my ability to pay the fees and
costs is true and correct:
(A) NAME:James E. Nestler, Jr.
ADDRESS: 3526 September Drive, Apartment 3, Camp Hill, Pa 17011
(B) EMPLOYMENT:
If you are presently employed, state:
EMPLOYER: (Not applicable)
ADDRESS:
SALARY OR WAGES PER MONTH:
TYPE OF WORK:
If you are presently unemployed, state:
DATE OF LAST EMPLOYMENT: 11/2006
SALARY OR WAGES PER MONTH: $5,000
TYPE OF WORK: project manager
(C) OTHER MONTHLY INCOME WITHIN THE LAST TWELVE (12) MONTHS:
BUSINESS OR SELF-EMPLOYMENT: $ 0
INTEREST OR DIVIDENDS: $ �
PENSION OR ANNUITIES: $ �
SOCIAL SECURITY OR S.S.I.: $ 2,900 (07/03/2014)
SUPPORT: � 0
UNEMPLOYMENT COMPENSATION: $ 0
WORKER'S COMPENSATION: $ 0
WELFARE: $ �
OTHER (Please specify): $ 0
(D) OTHER MONTHLY CONTRIBUTIONS TO HOUSEHOLD SUPPORT:
In re: SUZANNE JOSAPHINE NESTLER Petition for Waiver of Costs Page 2 of 4
.
SPOUSE'S NAME (if living together): (Not applicable)
If your spouse is employed, state:
EMPLOYER:
SALARY OR WAGES PER MONTH:
TYPE OF WORK:
CONTRIBUTIONS FROM CHILDREN: (None)
CONTRIBUTIONS FROM PARENTS: (None)
OTHER CONTRIBUTIONS: (None)
(E) PROPERTY OWNED:
CASH: (None)
CHECKING ACCOUNT: $2
SAVINGS ACCOUNT: $ 5
CERTIFICATES OF DEPOSIT, STOCKS, BONDS: (None)
REAL ESTATE/ HOME: (None)
MOTOR VEHICLE:
Year Make and mode/ Cost Amount
still owed
2009 Kia Spectra $ 13,990 $ 7,900
OTHER: (None)
(F) DEBTS AND OBLIGATIONS PER MONTH:
MORTGAGE/RENT: $ 1,035 WATER/SEWER: $ 50
ELECTRIC: $ 210 TELEPHONE: $ 240
OIUGAS/HEAT: $ 200 CABLE: � �
FOOD: $ 500 CLOTHING: $ 100
CHILD SUPPORT: $ 0 CHILD CARE: $ �
TRANSPORTATION: $ 450 MEDICAL EXPENSES: $ 80
LOAN PAYMENTS: $ 0 CREDIT CARD PAYMENTS: $ 300
INSURANCE: $ 32 MISCELLANEOUS: $ �
(G) PERSONS DEPENDENT UPON YOU FOR SUPPORT:
CHILDREN (STATE NAMES AND AGES):
Name Age
Connor J. Nestler 15 years
Suzanne J. Nestler 1 year
OTHERS (STATE NAME, AGE AND RELATIONSHIP):
Name Age Relationship
(None)
In re: SUZANNE JOSAPHINE NESTLER Petition for Waiver of Costs Page 3 of 4
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3. I understand that I have a continuing obligation to inform the court of any improvement in
my financial circumstances which would permit me to pay the cost incurred with this case.
4. I verify that the facts stated in the foregoing Petition are true and correct to the best of
my knowledge, information and belief. Petitioner understands that false statements therein are
subject to the penalties of 18 Pa. C.S.A. §4904 relating to unsworn falsification to authorities.
Date: � �� � L�
JA . NESTLER, JR., Petitioner
In re: SUZANNE JOSAPHINE NESTLER Petition for Waiver of Costs Page 4 of 4