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HomeMy WebLinkAbout02-1228IN THE 'COURT OF COMMON PLEAS OF CUMBERLAND coUNTy, PENNSYLVANIA CIVIL ACTION - LAW Plaintiff : Defendant : Civil Term NOTICE TO DEFEND AND CLAIM RIGHTS YOU HA VE BEENSUED IN COURT. If you wish to defend against the claims 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 bc 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 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, Cumberland County Courthouse, 1 Courthouse Square, Carlisle, Pennsylvania. IF YOU DO NOT FILE A CLAIM FOR ALIMONY, DIVISION OF PROPERTY, LAWYER'S 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. Cumberland County Bar Association 2 Liberty Avenue Carlisle, PA 17013 (717) 249-3166 Ee han demandado a usted a la corte. Si usted quiere defenderse en contra estas demandas expuestas en las paginas siguientes, usted tiene veinte (20) dias de plazo al partir de la fecha de la demanda y la notification. Usted debe presentar una aparieneia eserita o en persona o por abogado y archivar en la corte en forma escrita sus defensas o sus objeeiones a las demandas en contra suya. Se has avisado que si usted no se defienda, la corte tomara medidas y puede entrar una orden contra usted sin previo aviso o notificacion y por cualquier queja o alivio que es pedido en la peticion do demanda. USTED PUEDE PERDER D1NERO O PROPIENDADES O OTROS DERECHOS IMPORTANTES PARA USTED. LLEVE ESTA DEMANDA A UN ABOGADO INMEDIATAMENTE. SI USTED NO TIENE O CONOCES UN ABOGADO, VAYA EN PERSONA O LLAME POR TELEFONO A LA OFICINA CUYA DIRECCION SE ENCUENTRA ESCRITA ABA JO PARA AVERIGUAR DONDE SE PUEDE CONSEGUIR ASISTENCIA LEGAL. Cumberland CountyBarAssociation 2 Liberty Avenue Carlisle, PA 17013 (717)249-3166 AMERICANS WITH DISABILITIF.~ ACT OF 1990 The Court of Common Pleas of Cumberland County is required by law to comply with the Americans with Disabilities Act of 1990. For information about accessible facilities and reasonable accommodations available to disabled individuals having business before the Court, please contact our office. All arrangements must be made at least 72 hours prior to any heating or business before the Court. You must attend the scheduled Conference or Hearing. Cumbedand County BarAssociation 2 Liberty Avenue Carlisle, PA17013 (717)249-3166 Plaintiff Vo Defendant : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA : : NO. 2002- I ~ <~ : : CIVIL ACTION - LAW : IN DIVORCE o COMPLAINT UNDER §3301(c) or (d) OF THE DIVORCE CODE Plaintiff is Z,~ ~]d J. who currently resides at 3 Cumberland County, Pennsylvania. Defendant is J who currently resides at Plaintiff has been a bona fide resident of the Commonwealth of Pennsylvania for at least the six months prior to the filing of this Complaint. 4. Plaintiff and Defendant were married on at 5. The marriage is irretrievably broken, and the parties separated on 6. There have been no prior actions of divorce or annulment between the parities. 7. Plaintiff, to the best of his/her knowledge and belief, avers that defendant is not in the military service of the United States of America, but is in fact living at the address given in Paragraph 2 above. 8. Plaintiffhas been advised of the availability of counseling and that Plaintiff may have the right to request that the Court require the parties participate in counseling. WHEREFORE, Plaintiffrequests the Court to enter a Decree of Divorce. Date ~q~ain~iff, Pro Se I, 7<~r~Z~/t/,/ ~¥c£~fi,0/O/¢X$ verify that the statements made in this Complaint are true and correct to the best of my knowledge, information, and belief. I understand that false statements made herein are subject to the penalties for unswom falsification to authorities as provided in 18 Pa. C.S. §4904. I~ite Assisted by: MIDPENN LEGAL SERVICES PRO SE DIVORCE CLINIC 8 Irvine Row Carlisle, Pennsylvania 17013 (717) 243-9400 Plaintiff Defendant : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA : : NO. 2002- : : CIVIL ACTION - LAW : IN DIVORCE NOTICE TO DEFENDANT If you wish to deny any of the statements set forth in this affidavit, you must file a counter affidavit within twenty days after this affidavit has been served on you or the statements will be admitted. PLAINTIFF'S AFFIDAVIT UNDER §3301 (d) OF THE DIVORCE CODE parties to this action separated on --~c,~c~e_ Iff fl'~ 1. The live separate and apart for a period of two years. 2. The marriage is irretrievably broken. and continued to 3. I understand that I may lose rights concerning alimony, division of marital property, lawyer's fees, or expenses ifI do not claim them before a Divorce is granted. I, J~'.,cr~13~r~l cl . I. Ilk,If Lhl)~[~.f , verify that the statements made in this Affidavit are true and corre& to the best of my knowledge, information, and belief. I understand that false statements made herein are subject to the penalties for unswom falsification to authorities as provided in 18 P.S. Section 4904. Date Pro Se SOCIAL SECURITY INFORMATION SHEET PURSUANT TO 23 Pa.C.S.A. SECTION 4304.1 (a) (3) ALL DIVORCES MUST INCLUDE THE PARTIES SOCIAL SECURITY NUMBER PLEASE FILL IN THE APPROPRIATE INFORMATION AND RETURN TO THE PROTHONOTARY,S OFFICE DATE: DOCKET NUMBER: C) ~ - PLAINTIFF/PETITIONER SS# NAME: DEFENDANT/RESPONDENT SS ~.~ / NAME: ~ DIVORCE INFORMATION SHEET PURSUANT TO ACT 2001-82, VITAL STATISTIC FORMS ARE NOT REQUIRED BY THE STATE EFFECTIVE JANUARY 1, 2002. THE PROTHONOTARY IS REQUESTING THIS INFORMATION IN LIEU OF THE VITAL STATISTICS FORM. PLEASE FILL IN THE APPROPRIATE INFORMATION AND RETURN TO THE PROTHONOTARY'S OFFICE. DOCKET NUMBER: DATE OF MARRIAGE: Kimberly J. Burkholder, Plaintiff Vo Daniel L. Burkholder Defendant : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA :NO. 2002- /~o~ : CIVIL ACTION - LAW : : IN DIVORCE PETITION TO PROCEED IN FORMA PAUPERIS The Petitioner, Kimberly J. Burkholder, is the Plaintiff in this action. On her behalf, I, Joan Carey, attorney for MidPenn Legal Services, do hereby certify that the Petitioner is indigent according to the poverty guidelines of MidPenn Legal Services. MidPenn Legal Services is assisting the Petitioner in filing a divorce case pro se. The Petitioner's Financial Affidavit showing inability to pay the costs of litigation is attached hereto. Petitioner requests leave to proceed without payment of fees or costs. lyly , Attorney MidPenn Legal Serviceb Pro Se Divorce Clinic 8 Irvine Row Carlisle, PA 17013 VS. Pl~ntiff ~ Lbold Defendants : IN THE COURT OF COMMON PLEAS OF : CUIVIBERLAND COUNTY, PENNSYLVANIA : : NO. o~- CIVIL TERM : : AFFIDAVIT IN SUPPORT OF PETITION FOR LEAVE TO PROCEED IN FORMA PAUPERIS 1. I am the P h ;n~'~ 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 (a) Name: 4~,~r Address: oqo Co) Social Security Number: If you are presently employed, state Employer: Address: N Salary or wages per month: N//n, of work: IX/J~ Type If you are presently unemployed, state Date of last employment: I~ Salary or wages per month: Type of work: (_oD~cc (c) (d) Other income within the past twelve months Business or profession: kl Other self-employment: Interest: Dividends: Pension and annuities: hi Social Security benefits: ~ ~ ~10. oo Support payments: Disability payments: ~d / f~ Unemployment compensation and supplemental benefits: Workman' s compensation: Public Assistance: k~ Other: N / & Other contributions to household support (Wife)(I-Iusband) Name: ~d/fir If your (husband) (wife) is employed, state Employer: N I ~ Salary or wages per month: Nlm Type of work: {x4 I Contributions from children: Nlm (e) Property owned Cash:S ~D."° Checking Account:~ I Si) Savings Account: )-zoo.~O'°° Certificates of Deposit: Real Estate (including home): Motor vehicle: Make Cost Stocks; bonds: Other: (f) Debts and obligations Mortgage: Rent: ~ I 5%_3 .oo Monthly Expenses: Amount owed (g) Persons dependent upon you for support (Wife) (I-Iusband) Name: Children, if any: 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. 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. 4904, relating to unsworn falsification to authorities. Date: ,~-~&-G,2 Kimberly J. Burkholder Plaintiff Daniel L. Burkholder Defendant : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA : NO. 2002-1228 CIVIL ACTION - LAW : IN DIVORCE ACCEPTANCE OF SERVICE I, Daniel L. Burkholder, do hereby depose and say that I personally received and accepted service of a tree and correct copy of the Complaint in Divorce on the date written below. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S. §4904, relating to unswom falsification to authorities. Name of person accepting service Date KIMBERLY J. BURKHOLDER, Plaintiff DANIEL L. BURKHOLDER, Defendant : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA : : : NO. 2002-1228 : : : IN DIVORCE WAIVER OF NOTICE OF INTENTION TO REQUEST ENTRY OF A DIVORCE DECREE UNDER §3301(c) OF THE DIVORCE CODE 1. I consent to the entry of a final decree of divorce without notice. I understand that I may lose rights concerning alimony, division of property, lawyer's fees or expenses ifI do not claim them before a divorce is granted. 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 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. §4904 relating to unsworn falsification to authorities. Date: ~-/c-/-~7~ ~ff~b6r~ J. Burkholder KIMBERLY J. BURKHOLDER, Plaintiff Vo DANIEL L. BURKHOLDER, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 2002-1228 IN DIVORCE WAIVER OF NOTICE OF INTENTION TO REQUEST ENTRY OF A ° DIVORCE DECREE UNDER §3301 (c) OF THE DIVORCE CODE I consent to the entry of a final decree of divorce without notice. I understand that I may lose rights concerning alimony, division of property, lawyer's fees or expenses ifI do not claim them before a divorce is granted. 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 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. {}4904 relating to unsworn falsification to authorities. Signature.~~ ~[o~~x Daniel L. Burkholder KIMBERLY J. BURKHOLDER, Plaintiff DANIEL L. BURKHOLDER, Defendant : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA : : NO. 2002-1228 CIVIL : : IN DIVORCE AFFIDAVIT OF CONSENT 1. A complaint in divorce under §3301(c) of the Divorce Code was filed on March 2, 2002. 2. The marriage of plaintiff and defendant is irretrievably broken, and ninety days have elapsed from the date of filing and service of the Complaint. 3. I consent to the entry of a final decree of divorce after service of notice of intention to request entry of divorce. 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 unsworn fal~if~mation to authorities. Date: ~/~-tg,~ Signature~/~///~ ~)~' j'.~_~.~ ~_~ ) / i~m~y~.-B~rk~older ~ KIMBERLY J. BURKHOLDER, Plaintiff Vo DANIEL L. BURKHOLDER, Defendant : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA : : NO. 2002-1228 CIVIL : : IN DIVORCE AFFIDAVIT OF CONSENT 1. A complaint in divorce under §3301(c) of the Divorce Code was filed on March 2, 2002. o o The marriage of plaintiff and defendant is irretrievably broken, and ninety days have elapsed from the date of filing and service of the Complaint. I consent to the entry of a final decree of divorce after service of notice of intention to request entry of divorce. 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 unsworn falsification to authorities. Date: 7t/[ Daniel L. Burkholder Kimbefly J. Burkholder, Plaintiff V. Daniel L. Burkholder, Defendant To The Prothonotary: : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA .' : NO. 2002-1228 CIVIL : IN DIVORCE PRAECIPE TO TRANSMIT RECORD Transmit the record, together with the following information, to the Court for entry of a divome decree: 1. Ground for divorce: Irretrievable breakdown under Section 3301(c) of the Divorce Code. 2. Date and Manner of service of the Complaint: Defendant accepted service of the divorce, by agreement, on March 14, 2002, by Kimherly Burkholder. 3. 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, July 19, 2002; by Defendant, July 19, 2002. (b)(1) Date of execution of the Plaintiff's Affidavit required by Section 3301(d) of the Divorce Code: N/A (2) Date of filing and service of Plaintiff's Affidavit upon Defendant: N/A 4. Related claims pending: There are no outstanding claim~. 5. Complete either paragraph (a) or (b). (a) Date and manner of service of the notice of intention to file Pmecipe to Transmit Record, a copy of which is attached: N/A. (b) Date Plaintiff's Waiver of Notice in Section 3301 (c) Divorce was filed with the Prothonotary: July 31, 2002. (c) Date Defendant's Waiver of Notice in Section 3301 (c) Divorce was filed with the Prothonotary: July 31, 2002. Plaintiff's Social Security Number: 171-56-8683 Defendant's Social Security Number: 193-66-6182 Jo~ Carey ~) D~id A. Lopez Counsel for Plaintiff MidPenn Legal Services 8 Irvine Row Carlisle, PA 17013 (717) 243-9400 IN THE COURT OF COMMON PLEAS OFCUMBERLAND COUNTY STATE Of Plaintiff VERSUS DaHiel L. Burkholder, Defendant PENNA. N o. 02-1228 DECREE IN DIVORCE AND NOW, i~~ ~/(l~ yKtmberl J. Burk~older AND Daniel L. Burkholder ARE DIVORCED FROM THE BONDS OF MATRIMONY. 2002 , 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;