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HomeMy WebLinkAbout96-00299 '" L- a) ~ 0.. i I 0 I J) I 7 I c I 0 1; I 0'; ~ \ d ZJ ~ r- I J I I I I (J I I I (J i CO I .~ a / / STEVEN A. BLACKISTON, BOBBY E. BRIGHTWELL, JOHN A. NIGRO DERRICK D. FONTROY, PLAINTIFFS V. STEFAN PRESSER, ESQUIRE, DEFENDANT IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA . ; %-J.q<t CIVIL TERM ORDER OF COURT AND NOW, this 18th day of January, 1996, the petition to proceed in forma pauperis, IS DENIED. ./ / By the Court, ,: , Steven A, Blackiston, Bobby E, Brightwell, John A. Nigro, Derrick D. Fontroy P,O, Box 200 SMU Camp Hili, PA 17001-0200 / :saa c..~o ~<c.. i/,.",/%, -<'!>.f , \ /!/'::'\'C:P.,;: ("\\' ". '-"(,,'7'( 1._ , "" .:.., \ ,..,. .'J ~l ":i. ,..,J (1 ,~ ;. 'J . C'.. _Li, ( , .~ C? i:: il" i~ - -, 'r,S:"! C.; ~l ". ...... 9'.: - f....}:.;: . ", F-- . 01;;.:' ~.- ,. o;~: ~;~j ., , C.l" t...., , ~!l~. C;'..,; ."O_:'J -'~-. t:i.:! ....... '.~;j j. ~'~~ ~,jc.., "- l~ :5 I..) (;", <:... IN THE COURT OF COMMON PLEAS OF C. '" p.., br I'-.\...,,~t:> COUNTY L .J c. \ '-..) ,,-_ ~ I:~:)\ "... \ 0 COMMONWEALTH OF PENNSYLVANIA .~ cln.;::' ~ N' c..., "- c 'N" : (' \....... ..:::i\ . f (" VS. : C. \>..1 \~ 'I (" - ,;l'i '1 fJ.cvJ!...'.'1 ./,~ No. <'~'~{'>Yl.~ \~N_\'>(,~ <;q . t:I er-r ;;..(),,;-,.: . . OEFENOENT IN FORMA PAUPERIS STATEMENT -~ oW ~ 1'1. N . ~ "-.0 \-~ "-- states under penalties provided by 18 Pa. C. S. A. i 4904 ( unsworn falsification to authorities 1 that: 1. I am the defendant in the above action and because of my financial condition I am unable to pay the following fees and cost: 2. My responses to the questions below relating to my ability to pay the fees and cost are true and correct. (A) Are you presently employed? YES~> (1) If the answer is yes. state the amount of your salary or wages per month and giva the name and address of your employer. (2) If the answer is no. state the date of your last employment and the amount of salary or wages you received. (8) Have you received within the past 12 months any income from a business. profession or other form 01 self. employment. or in the form of rent payments. interest. dividends. pensions. annuities. social security benefits. support payments or other source? YES CND ~. If the answer is Yes. describe each source of income. and state the amount received from each during the past 12 months. (C) 00 you have a checking or savings account? YES dJ[:::, If the answer is Yes. state the total amount of each account. (0) List the persons. if any. who are dependent on you for support and state their relationship to you. . . " IN THE COURT OF COMMON PLEAS OF . PENNSYLVANIA COMMONWEALTH OF PENNSYLVANIA No, ."S' c'''' ~ 1'\, .::::. . c~ ..........\ '..l. "-.. \''-......S1,r-r VS. s:T c. ~ >1 G;::' ~'N'-\'!."-"-- ~" (?-. ::'t)~'" : VERIFICATION I. . verify that the statements made in the foregoing are true and correct to the best of my knowledge. information and belief. 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