notice to defend and claim rights · affidavit of service i, _____, hereby depose and say that on...

_____________________, Plaintif

vs.

______________________, Defendant

::::::::

IN THE COURT OFCOMMON PLEAS OF THE17TH JUDICIAL DISTRICT

OF PENNSYLVANIASNYDER COUNTY

BRANCH

CIVIL ACTION - LAWNO: ___________

NOTICE TO DEFEND AND CLAIM RIGHTS

You have been sued in court. If you wish to defendagainst the claims set forth in the following pages, you musttake prompt action. You are warned that if you fail to do so,the case may proceed without you and a decree of divorceor annulment may be entered against you by the court. Ajudgment may also be entered against you for any otherclaim or relief requested in these papers by the plaintif. Youmay lose money or property or other rights important toyou, including custody or visitation of your children.

When the ground for the divorce is indignities orirretrievable breakdown of the marriage, you may requestmarriage counseling. A list of marriage counselors isavailable at the Ofice of the Prothonotary at the SNYDERCounty Courthouse, 9 West Market Street, Middleburg,Pennsylvania.

IF YOU DO NOT FILE A CLAIM FOR ALIMONY,DIVISION OF PROPERTY, LAWYERS FEES OR EXPENSESBEFORE A DIVORCE OR ANNULMENT IS GRANTED, YOUMAY LOSE THE RIGHT TO CLAIM ANY OF THEM.

YOU SHOULD TAKE THIS PAPER TO YOUR LAWYERAT ONCE. IF YOU DO NOT HAVE A LAWYER, GO TO ORTELEPHONE THE OFFICE SET FORTH BELOW. THISOFFICE CAN PROVIDE YOU WITH INFORMATION ABOUTHIRING A LAWYER.

IF YOU CANNOT AFFORD TO HIRE A LAWYER, THISOFFICE MAY BE ABLE TO PROVIDE YOU WITHINFORMATION ABOUT AGENCIES THAT MAY OFFERLEGAL SERVICES TO ELIGIBLE PERSONS AT A REDUCEDFEE OR NO FEE.

Court AdministrationSnyder County Courthouse9 West Market St., PO Box 217Middleburg, PA 17842(570) 837-4344

_____________________, Plaintif

vs.

______________________, Defendant

::::::::


OF PENNSYLVANIASNYDER UNION COUNTY

BRANCH


COMPLAINT UNDER SECTION 3301 (c or d)OF THE DIVORCE CODE

1. Plaintif is _________________________, who currently resides at _____________________________________________,(Address) _______________________, (City)____________________, (County) _____________, (State) since __________________.(Date)

2. Defendant is _______________________, who currently resides at ____________________________________________, (Address) _______________________, (City) ___________________, (County) ______________, (State) since __________________.(Date)

3. Plaintif and/or Defendant has/ have been bona fide resident/ residents in the Commonwealth for at least six months immediately previous to the filing of this Complaint.

4. The Plaintif and Defendant were married on ____________ , in ________________________________________.(City, State, County)

5. There have been no prior actions of divorce or for annulment between the parties except __________________________________.

6. The marriage is irretrievably broken. 7. Plaintif has been advised of the availability of

counseling and the Plaintif may have the right to request the Court require the parties to participate in counseling.

8. Plaintif requests the Court to enter a decree of divorce.

DATED: ________________ _____________________________Plaintif

VERIFICATION

I verify that the statements made in the Complaint in Divorce are true and correct. I understand

that false statements made herein are made subject to the penalties of 18 Pa.C.S. 4904 relating to unsworn

falsification to authorities.

DATED: _____________ _____________________________ Plaintiff

CERTIFICATION OF COMPLIANCE

I certify that this filing complies with the provisions of the Public Access Policy of the Unified

Judicial System of Pennsylvania: Case Records of the Appellate and Trial Courts that require filing

confidential information and documents differently than non-confidential information and documents.

Submitted by: __________________________

Signature: _____________________________

Name: _______________________________

Attorney No. (if applicable): ______________

______________________, Plaintif

vs.

______________________, Defendant

::::::::



BRANCH


AFFIDAVIT OF SERVICE

I, _____________________, hereby depose and say that onthis date, I personally served the above captioneddefendant, with a Complaint in Divorce and Notice toDefend and Claim Rights with Notice of Availability ofCounseling, by personally handing the same to him/ her.

I verify that the statements made in this Afidavit aretrue and correct. I understand that false statements hereinare made subject to the penalties of 18 Pa.C.S. 4904relating to unsworn falsification to authorities.

Date:________________ __________________________

Plaintif

_____________________, Plaintif

vs.

______________________, Defendant

::::::::



BRANCH


ACCEPTANCE OF SERVICE

I, _____________________, Defendant in the above-captioned action depose and say that on this date, I herebyaccept service of the Complaint in Divorce and Notice toDefend and Claim Rights with Notice of Availability ofCounseling.

I verify that the statements made in this Afidavit aretrue and correct. I understand that false statements hereinare made subject to the penalties of 18 Pa.C.S. 4904relating to unsworn falsification to authorities.

Date:________________ _______________________

Defendant

_____________________, Plaintif

vs.

______________________, Defendant

::::::::



BRANCH


AFFIDAVIT OF SERVICECOMMONWEALTH OF PENNSYLVANIACOUNTY OF SNYDER

)))

I, _____________________, (Plaintif), being duly afirmedaccording to law, depose and says that:

1. On ______________ (date), a copy of the Complaintin Divorce was mailed to the Defendant byCertified Mail, Return Receipt, Deliver toAddressee Only, at the Defendants last knownaddress, as indicated on the attached mailingreceipt.

2. That on ______________ (date), the Defendantreceived the aforesaid Divorce Complaint and themailing receipt and the return receipt cardevidencing the same are attached hereto andmade part hereof.

Afirmed and subscribed

before me this ____ day of

__________ 20__.

Notary Public

My Commission Expires:

))))))))

_____________________ Plaintif

_____________________, Plaintif

vs.

______________________, Defendant

::::::::

IN THE COURT OF COMMON PLEAS OF THE

17TH JUDICIAL DISTRICTOF PENNSYLVANIA

SNYDER COUNTY BRANCH


AFFIDAVIT OF CONSENT1. A Complaint in Divorce under 3301(c) of the Divorce

Code was filed on _____________________.2. The marriage of the Plaintif and Defendant is

irretrievably broken and ninety days have elapsed from thedate of the filing and service of the Complaint.

3. I consent to the entry of a final decree of divorce afterservice of Notice of Intention to Request Entry of theDecree

I verify that the statements made in this Afidavit are trueand correct. I understand that false statements herein are madesubject to the penalties of 18 Pa.C.S. 4904 relating tounsworn falsification to authorities.

Date:________________ _______________________

Plaintif

_____________________, Plaintif

vs.

______________________, Defendant

::::::::

IN THE COURT OF COMMON PLEAS OF

THE17TH JUDICIAL DISTRICT

OF PENNSYLVANIASNYDER COUNTY BRANCH


AFFIDAVIT OF CONSENT1. A Complaint in Divorce under 3301(c) of the Divorce

Code was filed on _____________________.2. The marriage of the Plaintif and Defendant is

irretrievably broken and ninety days have elapsed from thedate of the filing and service of the Complaint.

3. I consent to the entry of a final decree of divorce afterservice of Notice of Intention to Request Entry of theDecree

I verify that the statements made in this Afidavit are trueand correct. I understand that false statements herein are madesubject to the penalties of 18 Pa.C.S. 4904 relating tounsworn falsification to authorities.

Date:________________ _______________________

Defendant

_____________________, Plaintif

vs.

______________________, Defendant

::::::::




WAIVER OF NOTICE OF INTENTION TO REQUEST ENTRYOF A DIVORCE DECREE UNDER 3301(c) and 3301 (d) OF

THE DIVORCE CODE1. 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, lawyers 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 filed with the Prothonotary.I verify that the statements made in this Afidavit are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. 4904 relating tounsworn falsification to authorities.

Date:________________ _______________________

Plaintif

_____________________, Plaintif

vs.

______________________, Defendant

::::::::




WAIVER OF NOTICE OF INTENTION TO REQUEST ENTRYOF A DIVORCE DECREE UNDER 3301(c) and3301 (d) OF

THE DIVORCE CODE1. 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, lawyers 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 filed with the Prothonotary.I verify that the statements made in this Afidavit 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:________________ _______________________

Defendant

_____________________, Plaintif

vs.

______________________, Defendant

::::::::




PRAECIPE TO TRANSMIT RECORDTo 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) OR 3301(d) of the divorce code.

2. Date and manner of service of the complaint: ______________________________________________________

3. Complete either paragraph (a) or (b).a. Date of execution of the Afidavit of Consent

required by 3301(c) of the Divorce Code:By Plaintif: __________________________By Defendant: _________________________b. 1) Date of execution of the Afidavit required by

3301(d) of the Divorce Code: ________________________________________________ 2.) Date of filing and service of the 3301 (d)Afidavitupon the opposing party: ________________________________

4. Related claims pending: ___________________________ or None 5. Complete either (a) or (b)

a. Date and manner of service of the notice of intentionto file praecipe, a copy of which is attached: ________________________________________________

b. Date Plaintifs Waiver of Notice was filed with the Prothonotary: _______________________

Date Defendants Waiver of Notice filed with the Prothonotary: _______________________

Date: __________ _____________________________ Plaintif

_____________________, Plaintif

vs.

______________________, Defendant

::::::::




DIVORCE DECREE

AND NOW, this ______ day of _______________, 20____, itis Ordered and Decreed that _______________________________,

Plaintif, and _____________________________, Defendant, aredivorced from the bonds of matrimony.

The court retains jurisdiction of any claims raised bythe parties to this action for which a final order has not yet beenentered.

Any existing spousal support order shall hereafter bedeemed an order for alimony pendente lite if any economicclaims remain pending.

BY THE COURT:

_________________________

J.

_____________________, Plaintif

vs.

______________________, Defendant

::::::::




PETITION FOR WAIVER OF COSTS1. I am the Plaintif in the above matter and because of my financial

condition am unable to pay the fees and costs of prosecuting or defending 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 thefees and costs is true and correct:

(a) NAME:ADDRESS:

(b) EMPLOYMENTIf you are presently employed, state:EMPLOYER:ADDRESS:SALARY OR WAGES PER MONTH:TYPE OF WORK:

If you are presently unemployed state:DATE OF LAST EMPLOYMENT:SALARY OR WAGES PER MONTH:TYPE OF WORK:

(c) OTHER INCOME WITHIN THE PAST TWELVE MONTHSBUSINESS OR PROFESSIONAL:OTHER SELF-EMPLOYMENT:INTEREST:

DIVIDENDS:PENSION OR ANNUITIES:SOCIAL SECRUITY BENEFITS:SUPPORT PAYMENTS:DISABILITY PAYMENTS:UNEMPLOYMENT COMPENSATION:WORKER'S COMPENSATION:PUBLIC ASSISTANCE:OTHER:

(d) OTHER CONTRIBUTORS TO HOUSEHOLD SUPPORTName of person contributing:Relationship to you:If your spouse contributes and is employed, state:EMPLOYER:SALARY OR WAGES PER MONTH:TYPE OF WORK:OTHER CONTRIBUTORS:

(e) PROPERTY OWNEDCASH:CHECKING ACCOUNT:SAVINGS ACCOUNT:CERTIFICATES OF DEPOSIT:REAL ESTATE (INCLUDING HOME) :MOTOR VEHICLE: MAKE: YEAR:

COST: AMOUNT OWED:STOCKS, BONDS:OTHER:

(f) DEBTS AND OBLIGATIONS PER MONTHMORTGAGE/RENT:UTILITIES: ELECTRIC: WATER/SEWER:OIL/GAS/COAL: PHONE:CABLE:LOANS:CREDIT CARDS:FOOD: NON-FOOD:CHILD SUPPORT:CHILD CARE:TRANSPORTATION COSTS:MEDICAL BILLS:BACK TAXES:MISCELLANEOUS HOUSEHOLD EXPENSES

(g) PERSONS DEPENDENT UPON YOU FOR SUPPORTCHILDREN, IF ANY: DO NOT USE MINOR CHILDRENS

NAME OR DATES OF BIRTH ON ANY PAPERWORK, ONLY ON CONFIDENTIAL FORM. DESIGNATION OF CHILD #1, 2, 3 etc. and AGE:__CHILD #1___________________________________

___________

______________________________________________ _________________________________________________________ _________________________________________________________ ___________

OTHER PERSONS:NAME:RELATIONSHIP:

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 afidavit are true and correct. I understand that false statements herein are made subject to the penalties of18 Pa. C.S. 4904, relating to unsworn falsification to authorities.

Date: ______________________, 20____ _________________________________(Signature of Plaintif) pro se

CERTIFICATION OF COMPLIANCE

I certify that this filing complies with the provisions of the Public Access Policy of the Unified Judicial

System of Pennsylvania: Case Records of the Appellate and Trial Courts that require filing confidential information

and documents differently than non-confidential information and documents.

Submitted by: __________________________

Signature: _____________________________

Name: _______________________________

Attorney No. (if applicable): ______________

_____________________, Plaintif

vs.

______________________, Defendant

::::::::




NOTICE OF INTENT TO RETAKE PRIOR NAME

A Divorce Complaint was filed on ____________________, 20 ____, in the above captioned matter. Notice is hereby given that Plaintif/Defendant hereby elects to retake and use her prior name of ___________________, and gives this written notice avowing her intention in accordance with the provisions of the 54Pa. C.S.A. 704(a).

_________________________Signature

TO BE KNOWN AS: __________________________(Print name to be known as)

_________________________(Sign name to be known as)

IN WITNESS WHEREOF, I have hereunto set my hand and seatthis ______ day of _________________, 20 _____.

_____________________________ (NOTARY)

_________________________________,PLAINTIFF

vs.

_________________________________,

DEFENDANT

::::::::

IN THE COURT OFCOMMON PLEASOF THE 17TH JUDICIAL DISTRICT


CIVIL - DIVORCE

NO:_______________

O R D E R

AND NOW this ____ day of ____________________, 20____, uponreview of the Petition for Waiver of Costs, which establishes that the Plaintif is without the financial resources to pay some or all of the costs of litigation, it is hereby ORDERED and DIRECTED that pursuant to Pa.R.C.P. 240, the Plaintif is permitted to proceed In Forma Pauperis, without prepayment of filing costs.

Parties permitted to proceed In Forma Pauperis must informthe Court of improvement in their financial circumstances which will enable them to pay costs. In the event that the party filing the Complaint retains counsel, the costs waived by this Order shall be due and payable within thirty (30) days of the entry of appearance of counsel or the appearance of counsel at any proceeding, unless, prior to the said proceeding Pa.R.C.P. 240(d) and the subparagraphs thereof are complied with in full, including the filing of: a certification by the attorney that he or she isproviding free legal services to the party and that he or shebelieves the party is unable to pay the cost; and the afidavit required by Pa.R.C.P. 240(d)(1)(ii).

BY THE COURT:

______________________________ J.

_____________________, Plaintif

vs.

______________________, Defendant

::::::::




NOTICE TO RESUME PRIOR SURNAMENotice is hereby given that the Plaintif/Defendant in the

above matter, (select one by marking X)

_____ prior to the entry of Final Decree in Divorce OR

_____ after the entry of a Final Decree in Divorce dated ___________,

hereby elects to resume the prior surname of _________________________,and gives this written notice avowing his/her intention pursuant to the provisions of 54 P.S. 704.

_________________________Signature

TO BE KNOWN AS: __________________________(Print name to be known as)

_________________________(Sign name to be known as)

IN WITNESS WHEREOF, I have hereunto set my hand and seat this ______ day of _________________, 20 _____.

_____________________________ (NOTARY)

_____________________, Plaintif

vs.

______________________, Defendant

::::::::

IN THE COURT OF COMMON PLEAS OF

THE17TH JUDICIAL DISTRICT


CIVIL ACTION - LAWCV- ___________

NOTICEIf you wish to deny any of the statements set forth in this

Afidavit, you must file a Counter-afidavit within twenty (20)days after this Afidavit has been served on you or the statementswill be admitted.

AFFIDAVIT UNDERSECTION 3301(d) OF THE DIVORCE CODE

The parties to this action separated on _________________ andhave continued to live separate and apart for a period of at one year.

1. The marriage is irretrievably broken.

2. I understand that I may lose rights concerning alimony, division of

property, lawyers fees or expenses if I do not claim them before a divorce is granted.

I verify that the statements made in this afidavit are true and correct. I understand false statements herein are made subject to the penalties of 18 Pa.C.S. 4904 relating to unsworn falsification to authorities.

Date: ________________ _____________________ Plaintif/ Defendant

Notice of Language Rights

Language Access CoordinatorKelly Heeter

9 West Market St. Middleburg/ 103 S. Second St. LewisburgSnyder & Union County Courthouse

570-837-4344/ 570-524-8792

English: You have the right to an interpreter at no cost to you. To request an interpreter, please inform court staff using the contact information provided at the top of this notice. Spanish/ Espaol: Usted tiene derecho a un intrprete libre de costo. Para solicitar un intrprete favor de informrselo al personal judicial utilizando la informacin provista en la parte superior de este aviso. Mandarin/Cantonese Simplified Chinese/ / : Mandarin/Cantonese Traditional Chinese/ / : /Arabic : .

.Russian /: . , . , . Vietnamese / Ti ng Vi t : Qu v c quy n c m t thng d ch vin gip m khng t n chi ph no c, xin hy bo cho nhn vin ta n dng thng tin lin l c c trn u thng bo ny. Nepali / : , Korean/ : . . Polish/Polski: Ma Pan/Pani prawo do nieodpatnego skorzystania z usug tumacza ustnego. Aby zwrci si o wsparcie ze strony tumacza ustnego, prosz skontaktowa si z pracownikami sdu, korzystajc z danych znajdujcych si w grnej czci niniejszego dokumentu. /Punjabi : Pakistan/

Punjabi/ /India: , ,

Portuguese/Portugus: Voc tem direito a um intrprete gratuitamente. Para solicitar um intrprete, informe nossa equipe usando os dados de contato mostrados na parte superior deste aviso. Somali/Somaali: Waxaad xaq u leedahay in lagu turjumo lacag laaan ah. Si aad u codsato turjumaanka, fadlan u sheeg maxkamadda shaqaalaha adiga oo isticmaala macluumaadka ciwaanka kor lagu siiyay ee ogeysiiskaan. Haitian Creole/ Kreyl Ayisyen: Ou gen dwa resevwa svis yon entprt gratis. Pou mande pou yon entprt,tanpri f manm psonl tribinal la konnen l ou svi avk enfmasyon an yo te bay ou nan tt avi sa a. French/Franais : Vous avez le droit de bnficier gratuitement de l'assistance d'un interprte. Pour en faire la demande, veuillez en informer le personnel du tribunal laide des coordonnes indiques en haut de page.

PRINT CONFIDENTIAL FORM/DOCUMENTS ANDDIRECTIONS (if necessary)

ALSO AVAILABLE ON COUNTY WEBSITEAND RETURN TO THE APPROPRIATE

COURT FILING OFFICE WITH OTHER FORMS.

COURT ADMIN/PROTHONOTARY NOTE: Also attach ENTRY OF APPEARANCE

notice to defend and claim rights · affidavit of service i, _____, hereby depose and say that on...

Documents