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Home My WebLink About06-4112 ~ II DAMON SHERRICK, : IN THE COURT OF COMMON PLEAS : OF CUMBERLAND COUNTY, PA. ~NO. CX.-4//2., (!iCJ1{T~ : CML ACTION - LAW : IN DIVORCE Plaintiff vs. MARY T. SHERRICK, Defendant NOTICE TO DEFEND AND CLAIM RIGHTS You have been sued 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 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 children, When the ground for the divorce is indignities or irretrievable breakdown ofthe marriage, you may request marriage counseling. A list of marriage counselors is available in the office of the Prothonotary at the Cumberland County Court House, One Courthouse Square, Carlisle, Pennsylvania 17013, IF YOU DO NOT FILE A CLAIM FOR ALIMONY, DMSION 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 TIllS 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 II DAMON SHERRICK, : IN THE COURT OF COMMON PLEAS : OF CUMBERLAND COUNTY, PA. ~ NO. Or,. ~ W/-Z ~ {~ Plaintiff VS. MARY T. SHERRICK, : CIVIL ACTION - LAW : IN DIVORCE Defendant A VISO PARA DEFENDER Y RECLAMAR DERECHOS USTED HA SIDO DEMANDADO EN LA CORTE, Si desea defenderse de las quejas expuestas en las paginas siguientes, debe tomar accion con prontitud, Se Ie avisa que si no se defiende, el caso puede proceder sin usted y decreto de divorcio 0 anulamiento puede ser emitido en su contra por la Corte, Una decision puede tambien ser emitida en su contra por cualquier otra queja 0 compensacion reclamados por el demandante. Usted puede perder dinero, 0 propiedades u otros derechos importantes para usted. Cuando la base para el divorcio es indignidades 0 rompimiento irreparable del matrimonio, usted puede solicitar consejo matrimonial. Una lista de consejeros matrimoniales esta disponible en la oficina del Prothonotry, en la Cumberland County Court House, One Courthouse Square, Carlisle, Pennsylvania 17013. S1 USTED NO RECLAMA PENSION ALIMENTICIA, PROPIEDAD MARITAL HONORARIOS DE ABOGADO U OTROS GASTOS ANTES DE QUE EL DECRETO FINAL DE DIVORCIO 0 ANULAMIENTO SEA EMITIDO, USTED PUEDE PERDER EL DERECHO A RECLAMAR CUALQUIERA DE ELLOS. USTED DEBE LLEV AR ESTE P APEL A UN ABOGADO DE INMEDIATO. S1 NO TIENE 0 NO PUEDE PAGAR UN ABOGADO, V AYA 0 LLAME A LA OF1CINA INDICADA ABAJO PARA A VERIGUAR DONDE PUEDE OBTENER AS1STENCIA LEGAL, Cumberland County Bar Association 2 Liberty Avenue Carlisle, PA 17013 (717) 249-3166 II DAMON SHERRICK, Plaintiff ; IN THE COURT OF COMMON PLEAS ; OF CUMBERLAND COUNTY, PA. ~ NO. 01. -4/1').. {!;uLL 'T~ ; CIVIT.. ACTION - LAW ; IN DIVORCE VS. I MARY T. SHERRICK, Defendant COMPLAINT UNDER SECTION 3301(c)OF THE DIVORCE CODE AND NOW, this l<i~ day of J"~ , 2006, comes the Plaintiff, Damon Sherrick, by his attorney, Jane M. Alexander, Esquire, and files this Complaint upon a cause of action of which the following is a statement, I. Plaintiff is Damon Sherrick, who currently resides at 29 Dogwood Building, Middletown, Borough of Middletown, Dauphin County, Pennsylvania 17057. 2, Defendant is Mary T. Sherrick, who currently resides at 622A Bridge Street, New Cumberland, Borough of New Cumberland, Cumberland County, Pennsylvania 17070. 3. Plaintiff has been a bona fide resident in the Commonwealth for at least six months immediately previous to the filing of this Complaint 4. The Plaintiff and Defendant were married on August 24, 1996 in Dauphin County, Pennsylvania by a Minister, 5, There were no children born between the parties during the marriage, 6. There have been no prior actions of divorce or for annulment between the parties, 7. The parties have not entered into a written agreement as to alimony, counsel fees, cost and property division. II 8, Plaintiff has been advised that counseling is available and that Plaintiff may have the right to request that the court require the parties to participate in counseling. 9, The marriage is irretrievably broken, WHEREFORE, the Plaintiff prays your Honorable Court to enter a Decree of Divorce from the bonds of matrimony. Respectfully submitted, . Alexa A orney for Plai I ,No. 07355 48 South Baltimore Street DiIlsburg, P A 17019 (717) 432-4514 . - IT' Verification I verify that the statements made in this Complaint in Divorce 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. /~?A aon 'SIlerrick Date: 7/1"1/~o{, - COMMONWEALTII OF PENNSYLVANIA S,S COUNTY OF YORK Before me, the undersigned officer, a Notary Public, in and for the said Commonwealth and County, Personally appeared Damon Sherrick, who, being affirmed according to law, deposes and says that the facts and matters set forth in the foregoing Complaint are true and correct to the best of his knowledge, information and belief Sworn to and subscribed before me this I "I<:!' day of (1' ~ . 2006 ~ Notary Public COMMONWEALTH OF PENNSYLVANIA Notarial Seal Narumol Alexander, No!aIy Public DiIlsburg BolO, YOlk County My Cornmlaion Expiresl'(x. 7, 2010 Member, Pennsylvania Association of Notaries ~ ~ ~ ~r:~~ _ _ Ii) ~ ~ () ~ - -:U ~ F- S ,. . c;>--" ...-\ '( '~'~ , f',,) C~) , -:.-- :::.{. C.' II DAMON SHERRICK, : IN THE COURT OF COMMON PLEAS : OF CUMBERLAND COUNTY, PA. Plaintiff vs. : NO. 06-4112 Civil Term MARY T, SHERRICK, : CIVIL ACTION - LAW : IN DIVORCE Defendant AFFIDAVIT OF SERVICE AND NOW, this, ~J~y of 2006 personally appeared Jane M, Alexander, Esquire who sw according to , that a true and correct copy of a COMPLAINT IN DIVORCE was caused to be served by certified mail with return receipt requested upon the said, Mary T, Sherrick 622A Bridge Street New Cumberland, P A 17070 on July 20, 2006 by leaving the same at the Dillsburg Post Office with postage pre-paid thereon as evidenced by the mailing receipt and return receipt hereto attached and made a part Sworn and subscribed before me this 2? I ~ day of ,2006. ~~ ~ Notary Public COMMONWEALTH OF PENNSYLVANIA Notarial Seal NarumoI Alexander, Notary PIlllIic OiIlsburg Boro, YOlk Coooty My Commission E>cpIres~. 7, 2010 Member, Pennsylvania AssociaUon of Notarlel II DAMON SHERRICK, : IN THE COURT OF COMMON PLEAS : OF CUMBERLAND COUNTY, PA. Plaintiff VS. : NO. 06-4112 Civil Term MARY T. SHERRICK, : CIVIL ACTION - LAW : IN DIVORCE Defendant PROOF OF ~EIlVlCE <0 <0 :r :r t J '1 ~) , ; ,1' '-....1. , CERTIFIED MAIL RECEIPT (DomestIc Mall Only, No Insurance Coverage ProvIded) ...a LIl IT1 ...a IT1 e e e e LIl l"- e :r g 0 Mtt", T. 6[,.urlc I"- lf6i'iI;'Ai><lli&;:-....L.....,....,.........,......... .., m.............m.... orFOBOd'O.' ~:1:1- A 'e>rtd~L stru.-t lii6o;Si8ii'Z/;;;<........-.............................'..-........................... Nw ~b<<i1U'l<l 1'A. 17crro ~Feo $2.40 Rolum _Feo $1.85 (EndolwomenI_1'Id) ReeIrIcted DelMlr'y FN $3.70 lS-Roq"1'Id) Total Po6t8ge & Fee8 $ $8.58 ~ \:p ~,\'_\ '01";'" ~(, (fl.", _E.. r~ \:2"0' i' (_ ~,,,. :;.r t._~ 3. ...;! '* ~ ~ ~t ~ ""Q - ~Q ..." ~~\ Q~ ~ 6~ "'" <e ~ ":!t.. c..:> o II DAMON SHERRICK, : COURT OF COMMON PLEAS : OF CUMBERLAND COUNTY, PENNA. Plaintiff VS. : NO. 06-4112 Civil Term MARY T. SHERRICK, Defendant : CIVIL ACTION - LAW : IN DIVORCE AFFIDAVIT OF CONSENT 1. A Complaint in Divorce under ~ 3301(c) of the Divorce Code was filed on July 20, 2006. 2. The marriage of Plaintiff and Defendant is irretrievably broken and ninety (90) days have elapsed from 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 the decree. I verify that the statements made in the 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: J.J8-o; ,,,./' C) C ~~~, t-' ~:-....;;> '3 --- ~... ..,,,-~~ ?J ~ - v) e;? II DAMON SHERRICK, : COURT OF COMMON PLEAS : OF CUMBERLAND COUNTY, PENNA. Plaintiff VS. : NO. 06-4112 Civil Term MARY T. SHERRICK, Defendant : CIVIL ACTION - LAW : IN DIVORCE WAIVER OF NOTICE OF INTENTION TO REQUEST ENTRY OF A DIVORCE DECREE UNDER CODE SECTION 3301(C) OF THE DIVORCE CODE 1. 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 tiled with the Prothonotary . 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: J.J8~o I J .' /.:7 J j ,jL~n sh;~cb .- \~ o ~;~ t'. r-" c.-.-) S :> ""'t.~ :;0 - (,.,0 OJ .- .,.- """. .;;:.- II DAMON SHERRICK, : COURT OF COMMON PLEAS : OF CUMBERLAND COUNTY, PENNA. Plaintiff VS. : NO. 06-4112 Civil Term MARY T. SHERRICK, Defendant : CIVIL ACTION - LAW : IN DIVORCE AFFIDAVIT OF CONSENT 1. A Complaint in Divorce under S 3301 ( c) of the Divorce Code was filed on July 20, 2006. 2. The marriage of Plaintiff and Defendant is irretrievably broken and ninety (90) days have elapsed from 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 the decree. I verify that the statements made in the Affidavit are tme and correct. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S. S 4904 relating to unsworn falsification to authorities. Date: 3/-' J tq ~1.~ Mary T. emck ;;.~ 0 ',;':J ....n ......J :r: ~O;!!j w CD .r::- .t:='"' - 11 DAMON SHERRICK, : COURT OF COMMON PLEAS : OF CUMBERLAND COUNTY, PENNA. PlaintilT VS. : NO. 06-4112 Civil Term MARY T. SHERRICK, Defendant : CIVIL ACTION - LAW : IN DIVORCE WAIVER OF NOTICE OF INTENTION TO REQUEST ENTRY OF A DIVORCE DECREE UNDER CODE SECTION 3301(C) OF THE DIVORCE CODE 1. 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 in 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 talse statements herein are made subject to the penalties of 18 Pa. C.S. ~ 4904 relating to unsworn falsitication to authorities. Date: 3lt/of ~ .1~ -Jary ~herrick ,j ~ ~3 ...-:- -,,"-"" '):J.t. -';;"J - w C!? o -fl --', ::I: -n r\1e -t-; 1,.':A :S)i;:S, ;._ M"\', :.~'i~ ~~f~ --:-:~~ --r-". :!l .r:'" s::- 1\ DAMON SHERRICK, : COURT OF COMMON PLEAS : OF CUMBERLAND COUNTY, PENNA. Plaintiff VS. : NO. 06-4112 Civil Term MARY T. SHERRICK, Defendant : CIVIL ACTION - LAW : IN DIVORCE MARRIAGE SETTLEMENT AGREEMENT THIS AGREEMENT made this R8 ~ day of f &:J -(Wi{ ':j ,2007 by and between Damon Sherrick of 29 Dogwood Building, Middletown, Borough of Middletown, Dauphin County, Pennsylvania 17057 (hereinafter referred to as "HUSBAND") and Mary S. Sherrick, of 622A Bridge Street, New Cumberland, Borough of New Cumberland, Cumberland County, Pennsylvania 17070 (hereinafter referred to as "WIFE".) WITNESSETH: WHEREAS, HUSBAND and WIFE were married on August 24, 1996 in Millersburg, Dauphin County, Pennsylvania. HUSBAND instituted an action in divorce to No. 06-4112 in the Court of Common Pleas of Cumberland County, Pennsylvania on July 20,2006. The pleadings in the case requested dissolution ofthe marriage between the two parties and for such further relief that the Court may deem equitable and just; and WHEREAS, the parties have reached an agreement as to the settling of aU matters relating to the divorce. NOW, THEREFORE, in consideration of the promises and the mutual promises, covenants and undertakings hereinafter set forth and for other good and valuable consideration, receipt of which is hereby acknowledged by each of the parties hereto, Page 1 of7 II consideration, receipt of which is hereby acknowledged by each of the parties hereto, HUSBAND and WIFE, each intending to be legally bound, hereby covenant and agree as follows: I. The parties intend to maintain separate and permanent domiciles and to live apart from each other. It is the intent and purpose of this Agreement to set forth the respective rights and duties of the parties while they continue to live apart from each other. 2. The terms of this Agreement and their effect have been fully explained to the HUSBAND by his counsel, Jane M. Alexander, Esquire. WIFE has been fully advised of her rights to seek counsel of her own and has chosen not to do so. The parties acknowledge that they have received independent legal advice from counsel of their choice and have been fully informed as to their legal rights and obligations. The parties understand the facts and acknowledge and accept this Agreement as fair and equitable. 3. The parties have attempted to divide their matrimonial property in a manner which conforms to a just and right standard, with due regard to the rights of each party. It is the intent of the parties that such division shall be final and shall forever determine their respective rights. The division of existing marital property is intended by the parties to constitute in any way a sale or exchange of assets, and the division is being affected without the introduction of outside funds or other property not constituting a part of the marital estate. 4. Neither party shall molest, harass, annoy, injure, threaten or interfere with the other party in any matter whatsoever. Each party may carry on and engage in any employment, profession, business or other activity as he or she may deem advisable for his or her sole use and benefit. Neither party shall interfere with the uses, ownership, enjoyment or disposition Page 2 of7 ----- - - -11- of any property now owned and not specified herein or property hereafter acquired by the other. 5. The consideration for this contract and agreement is the mutual benefits to be obtained by both ofthe parties hereto and the covenants and agreements of each of the parties to the other. The adequacy of the consideration for all agreements herein contained is stipulated, confessed, and admitted by the parties, and the parties intend to be legally bound hereby. 6. DEBTS OF THE PARTIES: It is further mutually agreed and understood by and between the parties that all joint debts have been paid including open accounts, credit cards, and bank liabilities except as hereinafter set forth: 6.1) The HUSBAND shall assume all liability for and pay and indemnify the WIFE against liability for all debts and bills in his name alone, particularly those incurred since date of filing Complaint in Divorce. 6.2) The WIFE shall assume all liability for and pay and indemnify the HUSBAND against liability for all debts and bills in her name alone, particularly those incurred since date of filing Complaint in Divorce. 7. PERSONAL PROPERTY: As to all items of personal property which the parties have divided to their mutual satisfaction, henceforth, each of the parties shall own, have and enjoy independently of any claim or right of the other party, all items of personal property of every kind, nature and description and wherever situated, which are now owned or held by or which may hereafter Page 3 of7 II belong to the HUSBAND or WIFE, with full power to the HUSBAND or the WIFE to dispose of same as fully and effectually, in all respects and for all purposes as if he or she were not married. Specific disposition of major items or personal property is as follows: 7.1) Bank Accounts: Each party has opened and maintained their own separate bank accounts since the time of separation. Neither party will make a claim against those funds. 7.2) Vehicles: a) HUSBAND shall retain possession, title, and sole ownership to the following vehicle: 2002 Ford Explorer and be responsible for debt of any thereon. b) WIFE shall retain possession, title and sole ownership to the following vehicle: 2004 Suzuki and be responsible for debt, if any, thereon. 7.3) Household furnishings: The parties have divided the household furnishings to their mutual satisfaction and each retains possession of their personal. 7.4) Pensions: Stock options. Retirement funds. !RAs: Neither party at date of separation owned or maintained any pension plan, stock options, retirement funds or !RAs subject to equitable distribution. 8. SPOUSAL SUPPORT/ALIMONY: Neither party has or will make claim for spousal support and/or alimony. 9. BANKRUPTCY: The parties hereby agree that the provision of the Agreement shall not be dischargeable in bankruptcy and expressly agree to reaffirm any and all obligations contained Page 4 of7 II I Ii herein. In the event a party files such bankruptcy and pursuant thereto obtains a discharge of any obligations assumed hereunder, the other party shall have the right to declare this Agreement to be null and void and to terminate this Agreement in which the division of the parties' marital assets and all other rights determined by this Agreement shall be subject to court determination the same as if this Agreement had never been entered into. 10. STATUS OF SETTLEMENT: The property settlement as provided herein between the parties shall be considered an equitable distribution of marital property and both parties waive any and all rights or claims which they may have been entitled to raise with respect to the issue of equitable distribution under the Provisions of the Pennsylvania Divorce Act. 11. The parties agree that simultaneously with the signing of this Agreement they will sign the necessary affidavits of consent and affidavits acknowledging notice of marriage counseling in order to conclude the divorce action filed by HUSBAND under the no-fault provisions of the Pennsylvania Divorce Act. 12. The waiver or unenforceability of any term, condition, clause or provision of this Agreement shall in no way be deemed or considered to be a waiver of or forfeiture of right to enforce any other term, condition, clause or provision of this Agreement. 13. This Agreement shall be construed and interpreted according to the laws of the Commonwealth of Pennsylvania. 14. It is understood and agreed that the heirs, administrators, executors and assigns of the parties hereto shall be bound by all the terms, conditions, clauses and provisions of this Agreement. Page 5 of7 on - IN WITNESS WHEREOF, the parties hereto have set their hands and seals the day and year first above written, intending to be legally bound. r',. j}) ~ ,plimon Shemck, Plaintiff \-.. b-:z ~ Mary . Shernck, Defendant COMMONWEALTH OF PENNSYLVANIA : : S.S. COUNTY OF YORK On this, the .R8~ day of Fet\W(.~ ,2007, before me the undersigned officer, a Notary public, in and for said Commonwealth and County, personaliy appeared Damon Sherrick known to me (or satisfactorily proven) to be the person whose name is subscribed to the foregoing Marriage Settlement Agreement and in due form acknowledged that he executed the same for the purpose therein contained and desired the same to be recorded as such. WITNESS my hand and notarial seal the day and year aforesaid. ~~ Notary Public My Commission Expire: ~ 1 ) ~O( 0 COMMONWEALTH OF PENNSYLVANIA Notarial Seal Narumol Alexander, Notary Public Dnlsburg Bora, York County My Commission Expires Apr. 7, 2010 Member. P;~nnsyJvania Association of Notaries Page 60f7 II COMMONWEALTH OF PENNSYLVANIA : S.S. COUNTY OF YORK On this, the 5~ YV'lN~ day of , 2007, before me the undersigned officer, a Notary public, in and for said Commonwealth and County, personally appeared Mary 1. Sherrick known to me (or satisfactorily proven) to be the person whose name is subscribed to the foregoing Marriage Settlement Agreement and in due form acknowledged that she executed the same for the purpose therein contained and desired the same to be recorded as such. WITNESS my hand and notarial seal the day and year aforesaid. ~if"'->v"~~ Notary Public My Commission Expire: (~~ 7) .).OlO COMMONWEALTH OF PENNSYLVANIA Notarial Seal Narumol Alexander, Notary Public Dillsburg Boro, York County My Commission Expires Apr. 7, 2010 Member, Penns','lvania, Association of Notaries Page 7 of7 o ~,: t-,,) c:::::) ~ - ~ :.::". :;.0 o -n -\ -..,- -'- -r'l ,n [:, :'\~~1!..._~.1 .< 2. ''"{ '.::.:-!~,/ w !:~ co ~:... DAMON SHERRICK, Plaintiff : COURT OF COMMON PLEAS : OF CUMBERLAND COUNTY, PENNA. VS. : NO. 06-4112 Civil Term MARY T. SHERRICK, Defendant : CIVIL ACTION - LAW : IN DIVORCE PRAECIPE TO TRANSMIT RECORD To the Prothonotary: Transmit the record, together with the following information, to the Court for entry of a divorce decree: 1. Ground for divorce: irretrievable breakdown under ~3301(c) (3301(d)(l)) of the Divorce Code. (Strike out inapplicable section). 2. Date and manner of service of the complaint: was sent certified mail. restricted delivery and was served to the Defendant on July 22. 2006. 3. (Complete either paragraph (a) or (b)) a) Date of execution ofthe affidavit of consent required by ~3301(c) of the Divorce Code: by plaintiff February 28.2007 ; by defendant March 7.2007 . b) (1) Date of execution ofthe affidavit required by ~3301(d) ofthe Divorce Code: (2) Date of filing of the 3301(d) affidavit: (3) Date of service ofthe 3301(d) affidavit upon respondent: 4. Related claims pending: All claims are settled and satisfied by Marriage Settlement Agreement dated February 28.2007 signed by both parties. 5. (Complete either (a) or (b).) (a) Date and manner of service of the notice of intention to request entry of the divorce decree, a copy of which is attached: (b) Date plaintiff's Waiver of Notice was filed with the Prothonotary: March 13 .2007. Date defendant's Waiver of Notice was filed with the Prothonotary: March U .2007. Date: o/~c?1 ~? g ~; ~"n":'~' 12.S 'fl,': -<: .' ~r: ~i,i" 'i';"~J :2 ~ <:3 -eo '/oJ \ rV ~ ~e --om :;;Jt( S:~9, ..\. --"1. 7-'-\; >.1<6. t:/' >\ ~ ""'" ~ r::3 .- o J;:" ,.,.. ~ 1. ~ 1'/ /"?, -...."l?,n11 "~f }"I . f/'T h- . J . . r' ,.- II -?;P~?pp };:'" '}-1'iF'?W ~i ('tJ C]. !? ;, IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW ?rilOn ? Y?`C?! t? Plaintiff vs. 4scy, Defendant FILE NO. 9 6 - M!a' do IN DIVORCE cnA w CZ r Z . ?. C4 W NOTICE TO RESUME PRIOR SURNAME Notice is hereby given that the Plaintiff/Defendant in the above matter, having been granted a Final Decree in Divorce on the 3rbt day of ?? } oZ a ?? , hereby elects to resume the prior surname of c??m?YDS }C , and gives this written notice pursuant to the provisions of 54 P.S. 704. DATE: 04?? Signature a4u, 16-.- " Signature of me being resumed COMMONWEALTH OF PENNSYLVANIA : : SS. COUNTY OF CUMBERLAND On the 3d /" day of p0a , 20_ L_, before me, a Notary Public, personally appeared the above affiant known to me to be the person whose name is subscribed to the within document and acknowledged that he/she executed the foregoing for the purpose therein contained. In Witness Whereof, I have hereunto set my hand and official seal. lAlw /794± otary Public May rn a 9, J Qµ{ Z ll.WT' Q'IS Ca SA 91L aloZ CtL4