HomeMy WebLinkAbout95-06548
DUANE E. RENAUT,
plaintiff
: IN THE COURT OF cOMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
:
: NO. 95-fSI/S CIVIL TERM
v.
.
.
NANCY WEISS,
Defendant
FORA~:.i~~V~ ~:0~~:~0~~ ~~:~i~~~RIS
1. I aa the defendant in the above matter and becau.e of my
financial condition am unable to pay the fee. and co.t. of
pro.ecuting, defending, or appealing the action or proceeding.
2. I am unable to obtain funds from anyone, including my
fa.ily and a..ociates, to pay the costs of litigation.
3, I repre.ent that the information beloW relating to my
ability to pay the fee. and co.ts is true and correct.
(a) Na.e:
Nancv wet..
Addr...: 718 s. York S~r..t
M.Chanicabura. PA 170S5
social Security Number: 194-42-8829
(b) If you are pre.entlY e.ployed, state
ElIployer: None
Addre..: KIA
Salary or wage. per month: KIA
Type of work: N/A
If you are presentlY unemployed, state
Date of last employment: sentember 1995
Salary or wages per month: 91215.00
Type of work: Kiaht Auditor-Ramada Inn
(c) Other income within the past twelve months
Business or profession: 91215 for one month
other self-employment: Kone
Interest: None
Dividends: None
Pension and annuities: None
Social Security benetits: None
support payment.: Since Mav 1995 - S3984.00
Disability payments: None
Unemployment compensation and
supple.ental benetits: None
Workman'S compensation: None
Public A.sistance: S205.00 Der mo. from 1/95-5/95
other: divorC8 .etti...nt - 81500.00 in Mav 1995
(d) Other contributions to household support
(Wite (Husband) Na.e: None
It your (husband) (wite) is employed, state
Employer: NIA
salary or wages per month: NIA
Type ot work: -1J.JA
contributions from children: NIA
(e) Property owned
Cash: S20.00
Checking Account: None
savings Account: None
certiticates ot Deposit: None
Real Estate (including home): None
Motor vehicle: Make Ford
1995
Year
Cost leased
Amount owed
stocks I bonds: None
Other: None
(f) Debt. and obligation.
Mortgage I None
Rent I S220.00/mo.
Loan.: La... Dvm~. for car - S339.00/mo. Ford
Monthly Expen...: Talanhone-S30.00. Yn.urance-Sg..oo
c..olin&-S100.00. Grocari..-SBO.OO. Clothina-S20.OO
pr..criationa-a.o.oo. Laa.l r...-S50.00
(g) Per.on. dependent upon you for .upport
(Wife) (Hu.band) Name I None
Children, if any:
Na.el Age:
4, I under.tand that I have a continuing obligation to
infora the court of i.provement in my financial circu..tance.
which would perait .e to pay the co.t. incurred herein.
5. I verify that the .tate.ent. made in thi. affidavit
are true and correct. I under.tand that fal.. .tate.ent. herein
are .ade .ubject to the penaltie. of 18 Pa, C.S. 4904, relating
to un.worn fal.ification to authoritie..
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DI"IIC' JUSTICI JUDQMINY
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COM_.LlAr- 95-'591 (l.:..r.t 1'"'....-
NOTlCI O. APPIAL
................. the .lFP 11.,1 has filod In the oboYe Courl 01 c~ Plooo on oppeoI lrom the judgment rwndo<wd by the Diltrict .....tica on the
~_In the... .._I..... bel-.
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711 I, York Str.at, P.
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Roaa~~ E. K1air
go call
10/17/95
O. Box 1411, MecbaD\caburg,
,
Duau E, lleIIaut
PA 17055
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Legal Senic.., lac.
8 In1aa IIDW
B D n lWI
"appe/l8l1t was CLAIMANT (see Pa. R.c.P.J.P. No.
1001 (6) In action before DIstrict Justice, he MUST
FILE A COMPLAINT within twenty (2O) days afteI
filing his NOTICE of APPEAL..
y~r.
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TNI block wi be ,q..d ONLY when thIo notation 10 requlml under Po. R.c.P JP. No.
1001I.
TNI NallCIo of ,\flpeaI. when ....Md by the Diltrict Juotic., will opettI" OJ 0
..,..-..S III the ......... far pclIMSlIon In thIo CQM.
cv 19.
S/(1IIIfUII 01 ~ 01 Deputy
,.AlCIN TO INTlI lULl TO fiLl COMPLAINT AND lULl TO fiLl
(Ttr/I.-cf/DII d bm to be WId ONLY when appellBi1t was DEFENDANT (see Po. RC.P.J,P. No. l001(7) In action be/oIe D/s/rlcl JuslJce.
F NOr. USED, dIItIt:h from copy of notice of appeal /0 be seMJd upon appellee).
MAlC,". To Pwlll,,,,,oay
EnIrIr NIl' upon "..aft." a.nanl"
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(c-......No. ~1'. ~'i'I'I ~ -ru..--.... )Withlnl_Y(20IdayOuf"'~~,~~"'.'ofnan,..
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aULIa 'To hi...... R D.......... I app n..(.~
",.,. 01__')
. "I'P a 11(0). to file a _. .~olo'ln thII appeal
(11 You _ nollfied that a rule Is hereby on'-<l upon you to file a complalnl in thil appeal within '-'Iy (20) dayo aftw the dale af
...a of thIe .... upon you by pononal ....ic. 01 by certiliod 01 .'-<1 mall.
(2111 you do nol file a CQft1llalnt within this ~me. a JUDGMENT Of NON PROS W1I.lIE ENlPEO ~T yOO"
(311M..... of ..me. of this rule W ...m WOl by mail 10 the ..... al mailing.
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