HomeMy WebLinkAbout05-3338
,
fo rm 13
C',urY'lb"I'\a.nd
COUNTY COURT OF COMMON PLEAS
CIVIL COVER SHEET
- ,....,~'X
Docket No. ("')<,..:).J..j
I (a) PLAINTIFFS
DEFENDANTS
[I
(b) PLAINTIFF'S ATIORNEYS (ADDRESS)
7-01.. G- Me. EL
DEFENDANT'S ATIORNEY'S (IF KNOWN) (ADDRESS)
Yes or@
ill. ALTERNATE DISPIlTE RESOLUTION REOIlESTED
Summary Jury Trial
Other: See "Guide to Alternate Dispute
Resolution Programs" Published by the
County Bar Association
U. MANDATORY ARBITRATION
Does this faU under the mandatory arbitration
requirements per Local Rule 130 I?
N/A
IV. CAUSErS) OF ACTION (Cite the statutes or rules of law under which you are filing and write a brief statement
of causes( s).)
Divorce Code ~ 3301 (c) gvfdJ
V. GENERAL NATURE OF SUIT (Place an X in one area only that most accurately describes your case)
REAL PROPERTY
Condemnation
roredosure
_ Landlord & Tenant
Partition
_ Mechanics' Lien
_ Environment
Other. List
in IV above
_ Address of Property
(a) Is this an equity case?
VI. ORIGIN (Mark only I)
X 1 Original _ 2 Removed from
Complaint Federal Court
of Writ
PERSONAl. INJURY
Motor Vehicle
_ Product Liability
_ Medical Malpractice
_ Other Prof Liability
Intentional
Premises
Other - List in
IV above
DOMESTIC RELATIONS
-X- Divorce
_ Protection from Abuse
__ CustodyNisitation
~ Other - List in IV above
_ Support
CONTRACT
Insurance
_ PA Bond
_ Conection Suits
_ Construction
_ Other - List in
IV above
PRISONER PETITIONS
~ Habeas Corpus
_ Mandamus
Other - List in
IV above
OTHER STATUrES
_ Zoning Appeal
_ School Board Appeal
_ License Su:spension Appeal
_ Assessment Appeal
_ Other ~ List in IV above
_ LAHOR
_ TAX r IFN &
TAX MATIERS
OTHER
List in IV above
Yes or No
(b) Does it involve a governmental body? Yes or No
_ 3 Confessed _ 4 Transferred _ 5 Appeal
Judgments by From Another From
Complaillt District or G:Nt.
or Praecipe County (specify) Agency
._6 Appeal to _ 7 Foreign
Court from Judgment
Distrk't
Justice
judgment
VU. REQUESTED IN COMPLAINT N/ A
(a) Is this a CLASS ACTION YES or NO
(c) Amount demanded in complaint
Vill. RELATED CASErSllf ANY JUDGE
(b) Circle YES only if jury demanded in complain':
JURY DEMAND: YES or NO
Will you accept 6 jurors? YES or NO
DOCKET NUMBER
Case Caption
EY OF RECORD
Jv/Ve... 30) :tro~
DATE
192
,-
,
form 3
c...l'\-rl-\R~rJ t:llt'.kl M PrI..o/Je'1-
PLAINTIFF,
v.
( IN THE COURT OF COMMON PLEAS OF
(
(~\.lmB€R..U'lNl) COUNTY, PENNSYLVANIA
(
( CIVIL DIVISION
(
(NO: [)x>s- - j3W' C.~: (
"Z..olt'l- ~AIIES. Me (/ we(l.. ) ~("
DEFENDANT.
NOTICE TO DEFEND AND CLAIM RIGHTS
YOU HAVE BEEN SUED IN COURT. IF YOU WISH TO DEFEND AGAINST THE CLAIM
SET FORTH IN THE FOLLOWING PAGES, 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 THESE PAPERS BY THE PLAINTIFF. YOU MAY LOSE MONEY
OR PROPERTY OR OTHER RIGHTS IMPORTANT TO YOU, INCLUDING CUSTODY OR
VISITATION OF YOUR CHILD(REN).
WHEN THE GROUND FOR THE DIVORCE ARE 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 (.;"1/<./../5 LE I Cvm13E1?1 AAJh COUNTY
. PENNSYLVANIA.
IF YOU DO NOT FILE A CLAIM FOR ALIMONY, DIVISION OF PROPERTY, LAWYERS
FEES, OR EXPENSES BEFORE A DIVORCE OR 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.
LAWYERS REFERRAL SERVICE
C-tJfY\bw..\a..r\d en. BflR A "'scd~
?,~ S f/,p,\ ~l'?A s+ ('"..Ii.'.Ie. l PA
Telephone: (7/7) a'49-3/f.,f&,
~JI~ fJ/2JA tn~
For Petitioner
Address: :1.40 w. Colomb;t\. eel
EtJOI A ) PA /70~ ,
Telephone: 7/7- 7,~$?'-1...J1./ 7:>
179
form 6
COUNIT COURT OF COMMON PLEAS
INTAKE
THIS FORM MUST BE FILLED OUT IF YOU ARE FILING A DIVORCE OR CUSTODY
ACTION IN THE PROTHONOTARY'S OFFICE:
TODAY'S DATE:
:5LhJe 30) ;2,00")-
CASE NUMBER:
0-)" . :;Jyl.<
PLEASE CHECK ONE:
ii DIVORCE FILING - NO CHILDREN:
o DIVORCE FILING - W/CHILDREN UNDER 18:
o CUSTODY FILING - W/CHILDREN UNDER 18:
PLAINTIFF/PETITIONER NAME AND ADDRESS:
C.f'ITl1~~1V cilelJ 1Y'1f:"co/Je'j
.J.l}o W. (oLVlY\(W'I R\),
f~) \>A- 17o'J.S
DEFENDANT/RESPONDENT NAME AND ADDRESS:
'Z.OLlA GRAUf2S lY\e Elwe~
\"0T'C e \ {""~ ("
u " .__~;:.
182
form 4
C'.A\n4.~l.jr-.l €/leu
M F\ Lnf\Jg '1
PLAINTIFF,
( IN THE COURT OF COMMON PLEAS OF
(
( (1lJrY) f'..FR LPrN() COUNTY, PENNSYLVANIA
v, (
( CML DMSION
(
'Z.OL..f\ ~A-Oe~ "" c...GUuEt I ~R.. (NO: 0)- ,33~
DEFENDANT.
COMPLAINT IN DNORCE
AND NOW COMES, the Petitioner, C /H-I-l a.~ SitPtJ IY)AL(')I\JI:'f ' by FILING PRO SE,
who flies this Complaint in Divorce a statement of whic is as follow:
1. The Petitioner is C-Pt Ti1R~~ C ileu fr) "'" Cf\JE'1 . an adult individual currently residing
at ~L1C\ ill, ('.tlLllrne,l~ i?c> ENOl-A, ill"> l'7n;;l.S -
2. The Defendant is -z.ola. G.\I'AV~ ('(1, (,1 wee} 7\ r . an adult individual currently residing
at ~/' ;'"1'1'<''' if" l:,"''"'',
'" ,~.
3. The Petitioner has been a bona fide resident of the Commonwealth of Pennsylvania for at least six (6)
months previous to the filing of this Complaint.
4.
The Petitioner and Respondent were married on date: Oe-to b eR., 4 I J 9 <1 Y
of MAl/v€'
There (is) are...i2.- child(ren) born of this marriage. Name(s)
Birthdate( s):
6. Neither party is a member of any branch of military.
in the State
5.
7, The marriage is irretrievably broken.
S. The Petitioner, CI\'fI.\!?\~" I [jJ"'t-1 1V\l\ LnIuE'j ,respectfully requests this Honorable
Court to a grant this Divorce pursuant to Section 3301 (c), or in the alternative, Section 3301 (d) of
the Divorce Code.
Respectfully submitted,
Name: CA,l-1lG\j/V fAlpA I M ALM.JElf
Full Address: aLlo 1.0. COLlJN\P.IA I? f)
E /VO '-Po \ PA . /70::l.S'
Telephone: 7/7 - 7:J'ilr-l../ 473
1 verify that the statements made in the Complaint are true and correct. 1 understand that false
statements made herein are subject to penalties of 18 Pa. C.S.A. Section 4904, relating to unsworn falsification
to authorities.
Dated: ..Jut\Je 301 ;;),,00<)
Mre~
180
form 5
c.l1T\iRLliV Elte./.j M~Lcf..J \.j
\ ' 1:;/
PLAINTIFF,
v.
( IN THE COURT OF COMMON PLEAS OF
(
( CJjmBeR/""fWD COUNTY, PENNSYLVANIA
(
( CIVIL DMSION
(
(NO 0')' 333~
2.01...1"1 6-R~E~ Me E'LWEC I 'SA.
DEFENDANT
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA )
) ss:
COUNTY OF: (:,UmBERLF\~D
)
Before me, the subscriber, a Notary Public in and for said Commonwealth and
County, personally appeared c'AT1~P-y'^( i-o</~ /'Vl4/", ".1/?,/ ,who being
duly sworn according to law, deposes and says that the facts contained within the foregoing
Complaint in Divorce are true and correct to the best of his/her knowledge, information, and
belief, and that he/she is authorized to make this Affidavit.
Sworn to and subscribed before me this
~~~:-)
Name h. )' I
">./1/ e/le -{en '7'
Sc:J day of JUNG'
,200.5 .
NOTARY PUBLIC
'~uiVlMONWEALTH OF PENNSYLVANIA
Notarial Seal
Danielle Hemy, Notary Public
Hampden Twp., CtJ'Tlberland COUnty
My Commission Expires May 21, 2008
_.-":::-'~--~':"'W!I/ania Association Of Notaries
181
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form 23
NOTICE TO FILE SOCIAL SECURITY NUMBERS
PURSUANT TO THE 23 P.S. SECTION 4304.1 (a) (3) PARTIES TO A DIVORCE ARE
REQUIRED TO PROVIDE THEIR SOCIAL SECURITY NUMBERS TO THE
COURT. PLEASE SUBMIT THE SOCIAL SECURITY NUMBERS OF THE
PARTIES TO YOUR DIVORCE TO THE PROTHONOTARY.
PLEASE FILL IN THE APPROPRIATE INFORMATION AND RETURN TO THE
PROTHONOTARY OFFICE-THESE INFORMATION SHEETS WILL BE KEPT IN
A SEPARATE FILE.
DATE:'3"OfUe. 30 I :<'00<;""
DOCKET NUMBER:
PLAINTIFFfPETITIONER ss#:
\ 7(- 3'6'- ~?'?,'1
NAME:
(' A-rnQ.,l.J~ GLLF/IJ IY'IA-l c^Je'1
\
DEFENDANT/RESPONDENT SS#: 3& 5{ - 7 fo - 7:>" '7<..,-
NAME:
?:...OLI'\ G-Q.P,ues /'f) c ellllEE ) Sr
Office of Clerk of Records
Prothonotary Division
County Courthouse
204
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(\a~R'1u E:l\el0 MI\-/())'Jf'i
PLAINTIFF,
( IN THE COURT OF COMMON PLEAS OF
(
( C.lJMbeV'Ia.MJ COUNTY, PENNSYLVANIA
(
( CIVIL DIVISION
(
L ol~ G.ro~ Me [Iwe... I Jr (NO:
DEFENDANT.
v.
CERTIFICATE (Proof) OF SERVICE
PLAINTIFF NAME: c.a.+hR.~\V <t:l1etJ M<<lo\lJe\.{ of
the Commonwealth of Pennsylvania, hereby affirms the following statement under penalty
of perjury:
I. I am the plaintiff in this action. I hereby certify that on ~ u IV e
200 S"' (DATE), I caused a copy of the attached:
NAME OF DOCUMENT: tCHI'lplqltJ1- (10 1\\}o>fre,
3b,
f
to be served upon
Defendant's NAME: ZoIC{ G...V'4ue" Me flwee) "J'r
ADDRESS: homele~"
by depositing a true copy of same enclosed in a post-paid properly addressed wrapper, in a
depository under the exclusive care and custody of the U.S. Postal Service within the
Commonwealth of Pennsylvania.
Dated: :r \JNe 30) :2.005-
~C~
NAME: C.~(~iJ t.. M"{<1'11~ '
Plaintiff
190
( IN THE COURT OF COMMON PLEAS OF
(
(
(
( CIVIL DIVISION
(
(NO:
PLAINTIFF,
v.
ACKNOWLEDGEMENT
form 10
A complaint in Divorce under Secti _/ _/_
I agree that the marriage of the Plaintiff a Defendant is irretrievably b oken and ninety days have elapsed
from the date of filing the Complaint. All info ation contained within e attached documentation is true and
correct to the best of my knowledge, informati ,and belief
It is my desire to file with the
attached Marital Property Settlement Agreement an
conditions as set forth within said Marital Property Set
County Court of Common Pleas the
to be b und fully and completely by the terms and
en J\greement documentation.
IN WITNESS WHEREOF, I set my hand and seal th'
NAME:
day of
,200_.
() ~ 0
C II':) 11
s: en
-Onl '- X
C9J~' c::: m:n
....__ ::z: j
;"71 ::g
~~. ~ 0
otary Pub~'the u~ersl j
Z (-;:kno~~
- t sh~xec~
:< t; ~
On this day of ,200_, before me, a
officer, personally appeared NAME
me to be the person whose name is su scribed to the written instrument) and ac
the same for the purposes therein c tained.
IN WITNESS WHEREOF, I her unto set my hand and official seal.
Notary Public
189
. ~
fOTm 9
C'A'-\\...YG~ t..J
Ellel\J
v.
( IN THE COURT OF COMMON PLEAS OF
(
( turn bei~IQncl _COUNTY, PENNSYLVANIA
(
( CIVIL DIVISION
(
Me ElweQ);:re. (NO: C 5' - 33:)~
DEFENDANT.
IY\I1Lot..JC~
PLAINTIFF,
-z..o\A G.\Q.AU/S5
MARITAL PROPERTY SETfLEMENT AGREEMENT
THIS AGREEMENT, made this 2,0 ~ day of ~ I) tJe. . 200...s::....., between
PLAINTIFF, c.."'n-\I2.'1.\ EilelJ (Y'lALONe1,residingat J.40 LV, Lolvmblc. I'(J~
(city) G Nol<\ . Pennsylvania 170;)'.5'" (zip), hereinafter
called / "Wife," and
DEFENDANT, Z 0 I"
(city)
called "Husband" /
(,.,V'AiJE",M<.~iW<:'f'~~esiding at i'\Of<'ete<::S
. Pennsylvania
(zip), hereinafter
WI1NESSETH
WHEREAS, the parties were married on: (date) Oc-i-ober 4 I 1"1 q <4 .;
WHEREAS, the parties filed for 3301 ( c) Divorce on: (date) ;J \.iN e ~ I ;;loo)"
WHEREAS, the parties hereto desire to settle their property rights;
WHEREAS, both parties agree to relinquish any and all claims which either may have against
any property now owned or belonging to the other or which may hereinafter be acquired by either
of them by purchase, gift, devise, bequest, inheritance, or otherwise, except as to the obligations,
covenants, and agreements contained herein; and
WHEREAS, both parties each have had opportunity to seek the benefit of competent and
independent legal advise by separate counsel.
NOW; THEREFORE, the parties, intending to be legally bound, do covenant and agree as follows:
1. INCORPORATION OF RECITALS
The recitals on Page 1 of this Agreement are incorporated herein as if set forth in full. Each
paragraph hereof shall be deemed to be a separate and independent covenant and agreement.
2. APPLICABLE LAW
This Agreement shall be construed under the laws of the Commonwealth of Pennsylvania.
185
" .
3. PROPERlY TO BE RETAINED BY WIFE.
Husband and Wife agree that, unless otherwise indicated in this agreement, the Wife shall keep
all of her own personal clothing and effects; and that the following property shall also be retained by
the Wife:
11.j'l Ch eu'1 1?1l\ <::\?f
C-Ar'1R,\l\J ~oVQ,re.i~'" "B''\NK. CLC(...C!LWOU
~e\V"<j>iU\~r
lV\,cQ() 1.l;F\ U6
\),,,,,,,'1 \'co"" '-\uhl\:,
L"')I(
Lawl\l rno",,~("... ...,,,..J wad<er
iO~ B,Ke.
4, PROPERlY TO BE RETAINED BY HUSBAND.
Na.hoe AR.t ,-"orl(
(4tl1P"'i E'i~,ptrl\"lt -lent
G..-il\
'-\If\s HER
Vo."'CJ~IY\ c.I€.t1.l')er-
bb')
Husband and Wife agree that, unless otherwise indicated in this agreement, the Husband shall
keep all of his own personal clothing and effects, and that the following property shall also be
retained by the Husband:
'1!t.. OiOS De LrA 8'y
;;1.0" Color TV
.1," ColOR TV
bv D PU'l'l6R
VIOeo Pk"1er
Drt\ \ Pre~s (iT'l'\ +COOl:;.
(\\0. (0~i)I tI.meR
0.01'\"\'<.. BeaK COl/ecttL'f)
fk.twT1 j:','1 ",n!.. eei lee:l. cy\
G.o",,~ be-oJ ~o*('
ZOLA so\)We'SN Ba",iC Cicu:uNiI
))eSK
Sed
....,,~hts-\<l.l"\d
5. DEBTS TO BE PAID BY WIFE.
bile AND C\) S ) lJ'~O
Husband and Wife agree that the Wife shall pay the following debts and will not at any time
hold the Husband responsible for them:
CHA~E: l'lVro LOQ.N-:f ;).$'5''/
Salk \"nae School 1.0'>.1,).-$ 7S,/S"'
\),::,cove(' Cfetirt- OL,J -$ 04'7S'
C.HFI,l: C"e,l.t Q,J - -$ 1+,;).00
C..\-1ba.ni( C('e,\,~QVlJ'-f lJ '1 "IS'
l=\I"e.~l\l~ C""';\,r Qw.\ -$Is-oo
Co::.ecv':s tYe.!.t c",~-:Ii '13
\i'1..Ac:eR CUI' "JS0~.,..,ce.. - $4'75':
bppe-i ~\eo.\I"l "d - :{ .:15'0.
lMl1Q~l\I f11",cl.co1 boll:;, .... 300
~''-iOLlC\- IYlOR.t"~")", - SOc''"il.....'1'\)
8~...1C f 73,000
6. DEBTS TO BE PAID BY HUSBAND.
Husband and Wife agree that the Husband shall pay the following debts and will not at any time
hold the Wife responsible for them:
0\&." O"'lL I.. ~)" a.amc e.- <j; .:l So
Ccmcc,::s-r ~ $ 70
Zolo.. (l]et\,a,J.. b'db - $ 3s-0
186
7. PENSION AND/OR PROFIT SHARING PLANS, BANK ACCOUNTS, STOCKS, BONDS,
SECURITIES, CREDIT UNION ACCOUNTS, AND INDMDUAL RETIREMENT ACCOUNTS
Husband and Wife distribute the respective accounts as follows:
CAlt1~il\l Pe..'V~ION $ Is"OOTl;I'ICHcll FUND. WiFe. will Keef Pe",,;,CI\)
e.c.*,\^~tv 'Sove('e(~rJ BRN\'( ucco\.)I\J~. w,k w,11 /(€er g,tlUk 4CClL'Ylts
tC\tI'V"I'\) SO\J~"'.\rJ ~Al\.ll( :t l2.A . w. f.le (,v./I keep CicGCwnt.
<:'0\0.. Sc~...e(~N t,QnK Qcc..ou."i'\t. l-l",."bClMJ,. WIll Keee 1~lr...H( ac..c..oud.
8. REAL ESTATE
'Alil='e.. Own-s ('ea.l es\cd~. IOc,,<-kJ o...t ;240 IN. CC(ul'Y\Y-)JQ R.d.
c.l\Jc\C\ I p~ 110:;}S". W, ~ shed! re.mlN 'th~ p.rcFev~~ I
\.oJ, k (A.cl''''ee~\-c p~ c<.ll ma.\^i 1-0.( de6+~ k,+€'J ,IV palle S('Qph s-
h:> Co~'e(' bu~ -o-..<:i of H~e cfue..- pnd'j:S I rufe,)E'"5t.
9. ALIMONY, ALIMONY PENDENTE LITE, SPOUSAL SUPPORT, EXPENSES AND ALL
MARITAL RIGHTS
Each of the parties hereto release the other from subsequent claims for alimony, alimony
pendente lite, or spousal support, except as set forth as follows: f\j O~)C .
187
-..----- - .-. - '"-' -.-
, .
10. JOINT DEBTS
Husband and Wife warrant and certify to each other that there are no individual or joint marital
obligations outstanding, other than those listed in paragraphs 5 and 6 above.
1 1. DIVORCE
Husband and Wife agree that the marriage is irretrievably broken and will proceed with said
Divorce under 23 Pa. CA. Section 3301 (c).
12. TAX ADVICE
The transfers set forth herein may result in income, inheritance, estate, and other tax
consequences to the parties. The parties specifically acknowledge that no attorney involved in the
negotiating or drafting of this Agreement has provided any tax advised regarding the dispositions
contained herein. The parties have been advised to seek separate tax counsel concerning the
Divorce distributions.
IN WITNESS WHEREOF, the parties have hereunto set their hands and seals the day and year
first above written.
c-,.L .'
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Itness ,-,-
~
l~l lla....ft/t-Lt
Cn'Tl-llt't'" e'-/ltl\) 1\ LoNe'1
PLAINTI
r~~> '
C itness - ,/
~ )j.C%<2~~___~,
ND"ANT 7..ol", c;:.~s \VIe EII042e. , :r r
On this 3 n day of JlI N ~ . 200 S-. before me, a Notary Public, the undersigned
officer, personally appeared NAMES eft T?~ I~';I AI &,< J /~'" .ff1f/ f.,;;"vt.'7 and
7 /7 l' A GfZA-IJGiS j'YIc<?LW~~"'7::::::- .-r7Z. . known to me to be the persons whose names
are subscribed to the written instrument, and acknowledged that they executed the same for the purposes
therein contained.
IN WI1NESS WHEREOF, I hereunto set my hand and official seal.
""'"".---._ I ~'
~::i;2~
COMMONWEALTH OF PENNSYLVANIA
Notariat Seal
Danielle Henry, Notary Public
Hampden Twp., Cumbertand County
-\1v Commission Expires May 21,2008
188
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form 12
e",il-lr~N EII~l\) J\i~I\LOIJe'1--
PLAINTIFF,
v.
( IN THE COURT OF COMMON PLEAS OF
(
( 0.. \) IV) be v'lo.1">ct COUNTY, PENNSYLVANIA
(
( CIVIL DIVISION
(
(NO: 0 s..- 333 ({
2..010. G...j'(<~ tl\c. Fh.uel'
DEFENDANT.
PRAECIPE TO TRANSMIT RECORD
To the Prothonotary:
Kindly Transmit the Record, together with the following information, to the Court for entry of a
divorce decree:
I. Ground for Divorce: irretrievable breakdown under Section 330] (c) (" J10' (1) of the
Divorce Code. (Strike out applicable section.)
2. Date and manner of service of the Complaint: on or about GIVE DATE:
via (circle one) Personal Service or Certified Mail.
~ /,z,tJ /0 \
. .
3. (Complete either paragraph (a) or (b).)
(a) Date of execution of the Affidavit of Consent/Consent Waiver required by Section 3301 (c) of the
Divorce Code: by Plaintiff (I} /;l.f!;;/ OS); by Defendant ( II /;Zl?' / oS).
(b) (1) Date of execution of the Plaintiff's Affidavit required by Section 3301 (d) of the Divorce Code:
iI (.J..rr/o,>-
(2) Date of service of the Plaintiff's Affidavit required by Section 330 I (d) of the Divorce Code:
1/(2'6'(OS
4.
Related claims pending:
None.
Ca~ r /'V]cJ{Ate ~
Plainti~ - OC~ ~(~ fJ E, fVJ PlL.oNe y
Address: :l. 40 w Cot UI'Y.Io,C/ kef
CCNoic, JI'} /762\
Phone: ( 7/ 7) 7). 8""- If If 7 3
5. Date and manner of service of the Notice of Intention to me Praecipe to Transmit Record, a
copy of which is attached, if the Decree is to be entered under Section 330 1 (d) of the Divorce Code.
1I(;I.'6'IOS
191
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form 13
(',U In bQ.\' \ o.r\d
COUNlY COURT OF COl\'IMON PLEAS
CIVIL COVER SHEET
Docket No.. a-;-' '333~
I (.) PLAINTIFFS
DEFENDANTS
Eil I
(b) PLAINTIFF'S ATTORNEYS (ADDRESS)
7:..0'- c;... iVle.. E L
DEFENDANT'S ATTORNEY'S (IF KNOWN) (ADDRESS)
II. MANDATORY ARBITRATION
Does this fall under the mandatory arbitration
requirements per Local Rule 130 I?
m. ALTERNATE DISPUTE RESOLUTION REOUESTED
__ Summary Jury Trial
Other: See "Guide to Alternate Dispute
NI A Resolution Programs" Published by the
Yes or@ County Bar Association
IV. CAUSEISJ OF ACTION (Cite the statutes or rules of law under which you are filing and write a brief statement
of causes(s),)
Divorce Code ~ 3301 (c) gytdJ'
V. GENERAL NATURE OF SUIT
CONTRACT
Insurance
PA Bond
Collection Suits
Construction
Other - List in
IV above
(Place an X in one area only that most accurately describes your case)
REAL PROPERTY
Condemnation
foreclosure
Landlord & Tenant
Partition
Mechanics' Lien
Environment
Other ~ Ust
in rv above
_ Address of Property
(3) Is thi.s an equity case?
VI. ORIGIN (Mark only 1 ]
X~ 1 Original _ 2 Removed from
Complaint Federal Court
dWrit
PERSONAl INJURY
Motor Vehicle
_ Product Liability
_ Medical Malpractice
_ Other Prof Liability
Intentional
Premises
Other - List in
IV above
POMESTIC /lELATIONS
...X~ Divorce-
Protection from Abuse
_~_____ CustodyNisitation
Other - List in IV above
__ Support
PRISONER PETITIONS
~ Habeas Corpus
Mandamus
Oth~'f - List in
1V above
OTIfER STATUTES
_~ Zoning Appeal
.._ School Board Appeai
__ License Suspension Appeal
__ Assessment Appeal
Other - List in IV above
__ TAX LIEN &.
TAX MATTERS
!.IT.lIER
List in IV above
_I AilOR
Yes or No
(b) Does it involve a governmental body? Yes or No
3 Confessed
Judgments by
Complaint
or Praecipe
4 lransferred _"_ 5 Appeal
From Anomer From
Distrido)' Govt.
County (specify) Agency
~_6 Appeal to __
Court from
District
Justice
Judgment
7 foreip1
Judgment
VII. REQUESTED IN COMPLAINT NI A
(a) Is this a CLASS ACTION YES or NO
((~) Amount demanded in complaint
(b) Circle YES only if jury demanded in complaint:
JURY DEMAND: YES or NO
Will you accept 6 jurors? YES or NO
VIII. RELATED CASErSllF ANY JUDGE
DOCKET NUMBER
Case Caption
EY OF RECORD
J \&1t.. 2, () I ;).ro~
DATE
192
.#
..
fa rm 3
c..i'\nw..~rJ t:11~t..) M f'tLoNe'-{_
PLAINTIFF,
v.
( IN THE COURT OF COMMON PLEAS OF
(
( ~\JmBER.U'lI\l\)
(
( CIVIL DIVISION
COUNTY. PENNSYLVANIA
(
7...oll~ C-r<.AtlES, Mdt wee.. ) :Sf (NO JC\'l) - j33? c I ~: (
DEFENDANT.
NOTICE TO DEFEND AND CLAIM RIGHTS
YOU HAVE BEEN SUED IN COURT. IF YOU WISH TO DEFEND AGAINST THE CLAIM
SET FORTH IN THE FOLLOWING PAGES, 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 AGAlNST YOU FOR ANY OTHER CLAIM
OR RELIEF REQUESTED IN THESE PAPERS BY THE PLAINTIFF. YOU MAY LOSE MONEY
OR PROPERTY OR OTHER RIGHTS IMPORTANT TO YOU, INCLUDING CUSTODY OR
VISITATION OF YOUR CHILD(REN).
WHEN THE GROUND FOR THE DIVORCE ARE 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 c...A(<./..J~ U= I CvmRERt AIUl'> CQUN"lY
, PENNSYLVANIA.
IF YOU DO NOT FILE A CLAIM FOR ALIMONY, DIVISION OF PROPERTY, LAWYERS
FEES, OR EXPENSES BEFORE A DIVORCE OR 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 CA1'\TNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET
FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP.
LAWYERS REFERRAL SERVICE
C.VlY\bw...\a.nA en. BA~ It ~scx:i~
?,~ S fl,p,\ J;:oI'?J s+ ('c..II...le 1 PA
Telephone: [7/7) cF/9-3Jr..ro
Gilt'> fJ/~ mak;
For Petitioner
Address: ).40 LV. Columbia... €l/
1:::'-1(;( A . PA 170~ <:-
,
Telephone: 7 17 - 7~ ~- 4 '-1 7 3
179
form 23
NOTICE TO FILE SOCIAL SECURITY NUMBERS
PURSUANT TO THE 23 P.s. SECTION 4304. I (a) (3) PARTIES TO A DIVORCE ARE
REQUIRED TO PROVIDE THEIR SOCIAL SECURITY NUMBERS TO THE
COURT. PLEASE SUBMIT THE SOCIAL SECURITY NUMBERS OF THE
PARTIES TO YOUR DIVORCE TO THE PROTHONOTARY.
PLEASE FILL IN THE APPROPRIATE INFORMATION AND RETURN TO THE
PROTHONOTARY OFFICE-THESE INFORMATION SHEETS WILL BE KEPT IN
A SEPARATE FILE.
DATE '3" LlI0 e 30 17Z...CO<;-'
DOCKET NUMBER:
PLAJNTIFFfPETITIONER ss#:
\ 71 ~ 3<6 - C;-?,3 9
NAME: C r.-rnQ.u,N f;LLFl\J mr.-I CAJe'1
DEFENDANT/RESPONDENT SS#: 3& 'i{ - 7 Is> - 7 ;1'7')-
NAME:
'"Z.-Ol...'" C,..Q.JO\L;ES (V) c ElIl)EE~.c.._
Office of Clerk of Records
Prothonotary Division
County Courthouse
204
...
form 6
COUNfY COURT OF COMMON PLEAS
INTAKE
THIS FORM MUST BE FILLED OUT IF YOU ARE FILING A DIVORCE OR CUSTODY
ACTION IN THE PROTHONOTARY'S OFFICE:
TODAY'S DATE:
::J vue 30, ::2.00'J-
CASE NUMBER:
05" . 333'(<
PLEASE CHECK ONE:
ii DIVORCE FILING - NO CHILDREN:
o DIVORCE FILING - W/CHILDREN UNDER 18:
o CUSTODY FILING - W/CHILDREN UNDER 18:
PLAINTIFF/PETITIONER NAME AND ADDRESS:
c.-I"i'I1R"I10 cHeN IYlAI-oNe'1
'J,lfo ~'0. (J')U.JIY'~iPl R\),
n00/...A) \>A- I 70:;':;
DEFENDANT/RESPONDENT NAME AND ADDRESS:
"2..0LII"\ GAAuES, me El we~
,
'~ '){ l s? CS ~~
182
"'
-
form 4
U>. rH R.\1/'J € II e oJ
/V1 I't LoNe: ~
PLAINTIFF,
( IN THE COURT OF COMMON PLEAS OF
(
( (11 un f',F.R LA-IVD--COUNTY, PENNSYLVANIA
(
( CNIL DNISION
(
'LOLl"> G-(<A-ve~ f'Il c..6LW~ , :fR. (NO 0)'- "533i
DEFENDANT.
v.
COMPLAINT IN DIVORCE
AND NOW COMES, the Petitioner, C I'>r-.... a.~'-.l Sh..,,\ ffiALnlUc~ ,by FILING PRO SE,
who mes this Complaint in Divorce a statement of which is as follow:
I. The Petitioner is Coli f\1~~tJ t ilt:.1J fn ~ I O~lE'1 . an adult individual currently residing
at ;:l.Uf\ ill. ('.f\L\)M!3.If" 'VI" EIVOl-A, 1>"" 17,"'.:l.S .
2. The Defendant is "2.0\0.. (;:.V'AVe;:.<:.. (<)( U uJee I '~r ,an adult individual currently residing
at . J; { ~,.-" ,~~~
3. The Petitioner has been a bona fide resident ofthe Commonwealth of Pennsylvania for at least six (6)
months previous to the filing of this Complaint.
The Petitioner and Respondent were married on date: Oct-obe,R, 4 I 19<iY
of fY)A I I'JE
There (is) are -D- child(ren) born of this marriage. Name(s)
Birthdate(s) :
6, Neither party is a member of any branch of military.
4.
in the State
5.
7. The marriage is irretrievably broken.
8. The Petitioner, c.A'r'l-lO,,\,\ I fj/Pu IY\/\ LoAJF'j ,respectfully requests this Honorable
Court to a grant this Divorce pursuant to Section 330J (c), or in the alternative, Section 3301 (d) of
the Divorce Code.
Respectfully submitted,
Name: CAn-lel.j1V
Full Address: 0140 \.0 ,
GNOi...A,
~1If'A I 1Ylf:lLcl~IEI.t
COLlJi'Y\RIA t;?f)
PA. /70::1...<;;
Telephone: 7/7 - 7:') ~ - l..f 4 73
I verify that the statements made in the Complaint are true and correct. I understand that false
statements made herein are subject to penalties of 18 Pa. C.S.A, Section 4904, relating to unsworn falsification
t.o authorities.
Mer
8 /!1CQ~
Dated: ;rUf\le 30, ;)00')
180
.." ---- ....
-
form 5
tl1\1iRi~N GfretV MAI-C/Jc~
\
PLAINTIFF,
v.
( IN THE COURT OF COMMON PLEAS OF
(
( GiJme,eP..-IA'lND _COU!\.'TY, PENNSYLVANIA
(
( CIVIL DIVISION
(
(NO 0) 333~
2-01-1'\ G-Rf';VE~ Me !::U,JEC I SR
DEFENDANT,
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA )
) ss:
COUNTY OF: (:.UlnBERLAtJD
)
Before me, the subscriber, a Notary Public in and for said Commonwealth and
County, personally appeared ~A- TJ.. fLy A ( I;:? I'="1 ,rl/1/1/ "AI I?,/ , who being
duly sworn according to law, deposes and says that the facts contained within the foregoing
Complaint in Divorce are true and correct to the best ofhislher knowledge, information, and
belief. and that he/she is authorized to make this Affidavit.
~~~
~ _:?
Name .1~<'>./1ie/le
!-!e/7 <;Y
Sworn to and subscribed before me this
Sa day of JVNG
,200-'::'::> .
NOTARY PUBLIC
~0iVlivI0"WEALTH OF PENNSYLVANIA
Notarial5ea1
Daniel1e Henry, Notary Public
Hampden Twp" Ctrnbef1and County
r..~y Comrrlission Expires May 21,2008
,';VIllanii'! .Association Of Notaries
181
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form 17
CnrHRi,'J tlll:tJ Mc;/Cl'1e'1_
PLAINTIFF,
v.
( IN THE COURT OF COMMON PLEAS OF
(
(
(
CiJ rY> bHG l4.n&
COUNTY, PENNSYLVANIA
2,)lc, G.,'G;UeS lV\c. tiwee.,S,,"
DEFENDANT.
( CIVIL DIVISION
(
(NO:
AFFIDAVIT OF CONSENT
I. A complaint in Divorce under Section 3301 (c) of the Divorce Code was filed on (date:)QL/m..&.
2. The marriage of the Plaintiff and Defendant is irretrievably broken and ninety days have elapsed from the
date of filing and Complaint.
3 I consent to the entry of a final decree of Divorce after service of notice of intention to request entry of
the decree.
WAIVER OF NOTICE OF INTENTION TO REQUEST
ENTRY OF A DIVORCE DECREE UNDER
SECTION 3301 Cd OF THE DIVORCE CODE
I. I consent to the entry of a final decree of Divorce without notice.
2. 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.
3. I understand that I will not be divorced until a Divorce decree is entered by the Court and that a copy of
the decree will be sent to me immediately after it is filed with the prothonotary.
I verify that the statements made in this affidavit are true and correct. I understand that false statements here-
in are made subject to the penalties of 18 Pa C.S. Section 4904 relating to unsworn falsification to authorities.
Date: ~ /~/ OS
C'~ n 52"U J
Jr " './Uv-<4--" '- ',Io..V-. / 'I
. endant
198
()
-n
p,.)
c.::r
)")
\'.)
fa rm 16
e.f\Tt\\<..'-\N tile N
,
IV' F\ LON e '1
PLAINTIFF,
( IN THE COURT OF COMMON PLEAS OF
(
( Cu 1'(\ bl'X la I\lCLCOUNTY, PENNSYLVANIA
(
( CIVIL DIVISION
(
(NO: 0 S' - :)?:>.3 i
v.
ZoIc... &-f''''vc~ I'f\c.CL\Wl'e. I'S....
DEFENDANT.
AFFIDAVIT OF CONSENT
I. A complaint in Divorce under Section 3301 (e) ofthe Divorce Code was filed on (date:) Of., / -5D /20C.,':>
2. The marriage of the Plaintiff and Defendant is irretrievably broken and ninety days have elapsed from the
date of filing and Complaint.
3 I consent to the entry of a final decree of Divorce after service of notice of intention to request entry of
the decree.
WAIVER OF NOTICE OF INTENTION TO REQUEST
ENTRY OF A DIVORCE DECREE UNDER
SECTION 3301 ee) OF THE DIVORCE CODE
I. I consent to the entry of a final decree of Divorce without notice.
2. 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.
3. I understand that I will not be divorced until a Divorce decree is entered by the Court and that a copy of
the decree will be sent to me immediately after it is filed with the prothonotary.
I verify that the statements made in this affidavit are true and correct. I understand that false statements here-
in are made subject to the penalties of 18 Pa C.S. Section 4904 relating to unsworn falsification to authorities.
Date: ~ / Jli..../ ;)0 b 5'
Pl~ ~V\ ^~2~
197
(-~-~
-Ii
._~
~r
-Ii
,"'.)
C'~'}
I' '
p-.
tArH~~J E:lle.h.L...E'~~
PLAINTIFF,
v.
Zolo.. 6-'l-Pl~
Me Clwee ~('
J
DEFENDANT,
form 10
( IN THE COURT OF COMMON PLEAS OF
(
( C-vrnbeR.IQ.l'"
(
COUNTY, PENNSYLVANIA
( CIVIL DIVISION
(
(NO:
u.... ('~ 3-)-"
.J-.. :>.>3'
ACKNOWLEDGEMEl'.'T
A complaint in Divorce under Section 330 I (c) of the Divorce Code was filed on _Q_~_I_a~/ ;toO'}
I agree that the marriage of the Plaintiff and Defendant is irretrievably broken and ninety days bave elapsed
from the date of filing the Complaint. All information contained within the attached documentation is true and
correct to the best of my knowledge, information, and belief
It is my desire to file with the c'O(Y'l P,<;RLr'\lV D County Court of Common Pleas the
attached Marital Property Settlement Agreement and to be bound fully and completely by the terms and
conditions as set forth within said Marital Property Settlement Agreement dowmentation.
IN WITNESS WHEREOF, I set my hand and seal this Z~r- day of jJ()ibrJ bif ,200 5 ..
ChUvt DiIM mDo~
NAME: r:.tYrnR~tJ Ei~e~ IV\~OI\)ELf
OnthisC~l" day of !JOi..CmbV
officer, personally appeared NAME
me to be the person whose name is subscribed
the same for the purposes therein contained.
IN WITNESS WHEREOF, I hereunto set my hand and official seal.
&
Notary Public
COMMONWEALTH OF PENNSYLVANIA
Notarial Seal
Rona L. Magaro, Notary Public
East Pennsboro Twp., Cumbertand County
My Commission Expires Feb. 10,2008
Member. Pennsylvani3 Association Of Notaries
189
(:)
-n
~)
c:~
1"'-.:-'
''', ~
,-<..;
C- AIH R- ~ IJ E:.1I e tJ M A LOtJe 't
PLAINTIFF,
v,
2.010.. G-vq V% M c tl wee. , 'S'".
DEFENDANT.
form 10
( IN THE COURT OF COMMON PLEAS OF
(
( QUlnbeiLIa.nd__COUNTY, PENNSYLVANIA
(
( CIVIL DIVISION
(
( NO 0 Y - ~ y~ 8'
ACKNOWLEDGEMEl'o'T
A complaint in Divorce under Section 3301 (c) of the Divorce Code was filed on J:2.1tL..J":3.J::l.J ~Oas-
I agree that the marriage of the Plaintiff and Defendant is irretrievably broken and ninety days have elapsed
from the date of filing the Complaint. All information contained within the attached documentation is true and
correct to the best of my knowledge, information, and belief
It is my desire to file with the C LJmhp..Y'L.~AJ.i,) County Court of Common Pleas the
attached Marital Property Settlement Agreement and to be bound fully and completely by the terms and
conditions as set forth within said Marital Property Settlement Agreement documentation.
IN WITNESS WHEREOF, I set my hand and seal this Z 8fJo.... day of iJov&rJ 6 (;,.... , 200--5-,
:>~ rJj. ~c/'i~
NAME: -ZOIA G..Y"fHJES Mctlwee. )-S.....
On this 1. I?.f A.. day of NO iJ('..1r7 6er-- ,2005-. before me, a Notary Public, the undersigned
officer, personally appeared NAME Zo/o. (i-(rhf'.S me f /uff I iV"" ,known to
me to be the person whose name is subscribed to the written instrument, and acknowledged tbat she executed
the same for the purposes therein contained.
IN WITNESS WHEREOF, I hereunto set my hand and official seal.
~racl t7'la00/70
Notary Public U
COMMONWEALTH OF PENNSYLVANIA
Notarial Seal
Rona L. Magaro, Notary Public
East Pennsboro Twp., Cumberland County
My Commission Expires Feb. 10,2008
Member, Pennsylvania Association Of Notaries
189
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IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY
C_i'rn-l<l~N
ctlleJJ
STATE OF
PEN NA.
No.
OS"- 3~3 8"
VERSUS
z..o I ~
fV\e [\ weE;) "S r
<>-V'iC\\J~
DECREE IN
DIVORCE
AND NOW'~
-)..-I,m
~
,-~,
DECREED THAT
(11el0
MA(O/-ie,
1""...
C c:t~ r'1 '"
Me tlwee
AND
<..O\et
GvClIJ€S
ARE DIVORCED FROM THE BONDS OF MATRIMONY.
,...
IT IS ORDERED AND
, PLAINTIFF,
, DEFENDANT,
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;
NOfIJe
BdHE COU"T, ///
',,- -,!.t..
Ams'~
~ ~
PROTHONOTARY
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