HomeMy WebLinkAbout95-02612
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NO.
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Court of Common Pleas
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JUDGMEN'r NO'l'!':
9.1.!U1Jl.ll1i2.ll
/'Illchal1ioobura, Pennsylvania, JJlnuarYJ_J~, $ li.ll.lh,lIA
(plaoe) (date) (amount)
FOR VALUE RECElvt~D, I/WQ promise to pay to the order of WJl
Insuranoe Group. ~~~, MecbAnicsburg~JLl2!l~li. the sum of
Five Hundred Fiv!!..Allil 84/100 dollars, said sum to be payable as
follows!
r.U,ty dollars, ($150.00) on the First day of Februarv.
~ and Jtlll~ dollars, ($Q!LJl.Q) on the rll1t. day of eaoh and
every m2nth thereafter until the entir.e amount is paid in full.
UPON FAILURE to make payments as herein agreed, this note shall,
at the option of it~ holder, become immediately due and payable,
without demand or. notioe.
AND FURTHER, I/we do hereby authorize and empower the Prothonotary
or any attorney of any Court of Record of Pennsylvania or
elsewhere, to appear for and oonfeBs judgment for the sum due and
payable hereon, with or without deolaration, with costs of suit,
release of errors, without stay of execution I and also waive the
right of inquisition on any real estate that may be levied upon
to collect this note I and do hereby voluntar i ly condemn the same
and authorize the prothonotary to enter said voluntary
oondemnation upon any Fieri Faoias that may be issued to collect
said judgment I and further agree that said estate may be sold on a
Fieri Facias, and do hereby waive and release all relief from any
and all appraisement, stay of execution, exemption or bankruptcy
laws of this or any other state now in force or hereafter to be
passed. ::t ~ .. I _ _. 0 W
_~~~.{L.S.)
:~llh"~~ ~""'.JI4..(L.S.)
This note is given and exeouted without duress or coercion and
with full and complete understanding that upon failure to make
payment as agreed, that my operating privileges may be suspended.
Further, I do hereby acknowledge that the damages incurred in the
aooident of ffovember 15. 1994 for which this note is givon
resulted from my negligenoe and fault, and I do hereby aoknowledge
and waive my right to any hearing or trial on that issue.
"1 '/.1-'/1 _ = ~'.I
~~;~-~.1 '. ~L.S.)
DRIVER DATE OF BIRTH.
DRIVER OPERATOR NO.
OWNER DATE OF BIRTH
OWNER OPERATOR NO.
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