notice to defend and claim rights
TRANSCRIPT
: : : : : : : :
IN THE COURT OF COMMON PLEAS OF THE 17TH JUDICIAL DISTRICT
OF PENNSYLVANIA SNYDER COUNTY BRANCH
CIVIL ACTION - LAW
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 of the marriage, you may request marriage counseling. A list of
marriage counselors is available at the Office of the Prothonotary at the
SNYDER County Courthouse, 9 West Market Street, Middleburg,
Pennsylvania.
IF YOU DO NOT FILE A CLAIM FOR ALIMONY, DIVISION 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 THIS PAPER TO YOUR LAWYER AT
ONCE. IF YOU DO NOT HAVE A LAWYER, GO TO OR TELEPHONE
THE OFFICE SET FORTH BELOW. THIS OFFICE CAN PROVIDE
YOU WITH INFORMATION ABOUT HIRING A LAWYER.
IF YOU CANNOT AFFORD TO HIRE A LAWYER, THIS OFFICE
MAY BE ABLE TO PROVIDE YOU WITH INFORMATION ABOUT
AGENCIES THAT MAY OFFER LEGAL SERVICES TO ELIGIBLE
PERSONS AT A REDUCED FEE OR NO FEE.
Court Administration
Middleburg, PA 17842
: : : : : : : :
IN THE COURT OF COMMON PLEAS OF THE 17TH JUDICIAL DISTRICT
OF PENNSYLVANIA SNYDER UNION COUNTY
BRANCH
OF THE DIVORCE CODE
_____________________________________________, (Address)
____________________________________________, (Address)
______________, (State) since __________________.(Date)
3. Plaintiff 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 Plaintiff 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. Plaintiff has been advised of the availability of counseling and the
Plaintiff may have the right to request the Court require the parties to
participate in counseling.
8. Plaintiff requests the Court to enter a decree of divorce.
DATED: ________________ _____________________________
Plaintiff
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.
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: __________________________
: : : : : : : :
IN THE COURT OF COMMON PLEAS OF THE 17TH JUDICIAL DISTRICT
OF PENNSYLVANIA SNYDER COUNTY BRANCH
CIVIL ACTION - LAW
I, _____________________, hereby depose and say that on this date, I
personally served the above captioned defendant, with a Complaint in Divorce
and Notice to Defend and Claim Rights with Notice of Availability of
Counseling, by personally handing the same to him/ her.
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:________________ __________________________
Plaintiff
_____________________, Plaintiff
vs.
______________________, Defendant
: : : : : : : :
IN THE COURT OF COMMON PLEAS OF THE 17TH JUDICIAL DISTRICT
OF PENNSYLVANIA SNYDER COUNTY BRANCH
CIVIL ACTION - LAW
I, _____________________, Defendant in the above- captioned action
depose and say that on this date, I hereby accept service of the Complaint in
Divorce and Notice to Defend and Claim Rights with Notice of Availability of
Counseling.
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:________________ _______________________ Defendant
: : : : : : : :
IN THE COURT OF COMMON PLEAS OF THE 17TH JUDICIAL DISTRICT
OF PENNSYLVANIA SNYDER COUNTY BRANCH
CIVIL ACTION - LAW
) ) )
1. On ______________ (date), a copy of the Complaint in Divorce
was mailed to the Defendant by Certified Mail, Return Receipt,
Deliver to Addressee Only, at the Defendant’s last known
address, as indicated on the attached mailing receipt.
2. That on ______________ (date), the Defendant received the
aforesaid Divorce Complaint and the mailing receipt and the
return receipt card evidencing the same are attached hereto and
made part hereof.
this ____ day of __________ 20__.
17TH JUDICIAL DISTRICT OF PENNSYLVANIA
SNYDER COUNTY BRANCH
AFFIDAVIT OF CONSENT
1. A Complaint in Divorce under §3301(c) of the Divorce Code was filed
on _____________________.
2. The marriage of the Plaintiff and Defendant is irretrievably broken and
ninety days have elapsed from the date of the 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 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:________________ _______________________ Plaintiff
17TH JUDICIAL DISTRICT OF PENNSYLVANIA
SNYDER COUNTY BRANCH
AFFIDAVIT OF CONSENT
1. A Complaint in Divorce under §3301(c) of the Divorce Code was filed
on _____________________.
2. The marriage of the Plaintiff and Defendant is irretrievably broken and
ninety days have elapsed from the date of the 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 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:________________ _______________________ Defendant
17TH JUDICIAL DISTRICT OF PENNSYLVANIA
SNYDER COUNTY BRANCH
CIVIL ACTION - LAW NO: ___________
WAIVER OF NOTICE OF INTENTION TO REQUEST ENTRY OF A DIVORCE DECREE UNDER §3301(c) and §3301 (d) 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 filed 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:________________ _______________________ Plaintiff
17TH JUDICIAL DISTRICT OF PENNSYLVANIA
SNYDER COUNTY BRANCH
CIVIL ACTION - LAW NO: ___________
WAIVER OF NOTICE OF INTENTION TO REQUEST ENTRY OF A DIVORCE DECREE UNDER §3301(c) and§3301 (d) 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
filed 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:________________ _______________________ Defendant
17TH JUDICIAL DISTRICT OF PENNSYLVANIA
SNYDER COUNTY BRANCH
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 Affidavit of Consent required by §3301(c)
of the Divorce Code:
By Plaintiff: __________________________
By Defendant: _________________________
b. 1) Date of execution of the Affidavit required by §3301(d) of the
Divorce Code:
________________________________________________
2.) Date of filing and service of the §3301 (d)Affidavit upon 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 intention to file praecipe,
a copy of which is attached:
________________________________________________
_______________________
_______________________
PLEAS OF THE 17TH JUDICIAL DISTRICT
OF PENNSYLVANIA SNYDER COUNTY BRANCH
CIVIL ACTION - LAW
Ordered and Decreed that _______________________________, Plaintiff, and
_____________________________, Defendant, are divorced from the bonds of
matrimony.
The court retains jurisdiction of any claims raised by the parties to this
action for which a final order has not yet been entered.
Any existing spousal support order shall hereafter be deemed an order
for alimony pendente lite if any economic claims remain pending.
BY THE COURT:
17TH JUDICIAL DISTRICT OF PENNSYLVANIA
SNYDER COUNTY BRANCH
PETITION FOR WAIVER OF COSTS
1. I am the Plaintiff 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 the fees and costs is true and correct:
(a) NAME:
EMPLOYER:
ADDRESS:
TYPE OF WORK:
DATE OF LAST EMPLOYMENT:
TYPE OF WORK:
BUSINESS OR PROFESSIONAL:
Name of person contributing:
EMPLOYER:
TYPE OF WORK:
MORTGAGE/RENT:
(g) PERSONS DEPENDENT UPON YOU FOR SUPPORT
CHILDREN, IF ANY: DO NOT USE MINOR CHILDREN’S NAME OR
DATES OF BIRTH ON ANY PAPERWORK, ONLY ON CONFIDENTIAL
FORM.
__CHILD #1___________________________________ ___________
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 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.
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: __________________________
17TH JUDICIAL DISTRICT OF PENNSYLVANIA
SNYDER COUNTY BRANCH
NOTICE OF INTENT TO RETAKE PRIOR NAME
A Divorce Complaint was filed on ____________________, 20 ____, in the above captioned matter. Notice is hereby given that Plaintiff/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 54 Pa. 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 seat this ______ day of _________________, 20 _____. _____________________________ (NOTARY)
_________________________________, PLAINTIFF vs. _________________________________, DEFENDANT
17TH JUDICIAL DISTRICT OF PENNSYLVANIA
SNYDER COUNTY BRANCH
AND NOW this ____ day of ____________________, 20____, upon review
of the Petition for Waiver of Costs, which establishes that the Plaintiff 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 Plaintiff is
permitted to proceed In Forma Pauperis, without prepayment of filing costs.
Parties permitted to proceed In Forma Pauperis must inform the 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 she believes the party is unable to pay the
cost; and the affidavit required by Pa.R.C.P. 240(d)(1)(ii).
BY THE COURT:
17TH JUDICIAL DISTRICT OF PENNSYLVANIA
SNYDER COUNTY BRANCH
NOTICE TO RESUME PRIOR SURNAME
_________________________
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)
_____________________, Plaintiff
vs.
______________________, Defendant
17TH JUDICIAL DISTRICT OF PENNSYLVANIA
SNYDER COUNTY BRANCH
NOTICE
If you wish to deny any of the statements set forth in this Affidavit, you must
file a Counter-affidavit within twenty (20) days after this Affidavit has been served on
you or the statements will be admitted.
AFFIDAVIT UNDER
The parties to this action separated on _________________ and have
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, lawyer’s fees or expenses if I do not claim them before a divorce is granted.
I verify that the statements made in this affidavit 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: ________________ _____________________ Plaintiff/ Defendant
Language Access Coordinator
Kelly Heeter 9 West Market St. Middleburg/ 103 S. Second St. Lewisburg
Snyder & Union County Courthouse 570-837-4344/ 570-524-8792
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PRINT CONFIDENTIAL FORM/DOCUMENTS AND DIRECTIONS
(if necessary)
COURT FILING OFFICE WITH OTHER FORMS.
COURT ADMIN/PROTHONOTARY NOTE:
IN THE COURT OF COMMON PLEAS OF THE 17TH JUDICIAL DISTRICT
OF PENNSYLVANIA SNYDER COUNTY BRANCH
CIVIL ACTION - LAW
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 of the marriage, you may request marriage counseling. A list of
marriage counselors is available at the Office of the Prothonotary at the
SNYDER County Courthouse, 9 West Market Street, Middleburg,
Pennsylvania.
IF YOU DO NOT FILE A CLAIM FOR ALIMONY, DIVISION 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 THIS PAPER TO YOUR LAWYER AT
ONCE. IF YOU DO NOT HAVE A LAWYER, GO TO OR TELEPHONE
THE OFFICE SET FORTH BELOW. THIS OFFICE CAN PROVIDE
YOU WITH INFORMATION ABOUT HIRING A LAWYER.
IF YOU CANNOT AFFORD TO HIRE A LAWYER, THIS OFFICE
MAY BE ABLE TO PROVIDE YOU WITH INFORMATION ABOUT
AGENCIES THAT MAY OFFER LEGAL SERVICES TO ELIGIBLE
PERSONS AT A REDUCED FEE OR NO FEE.
Court Administration
Middleburg, PA 17842
: : : : : : : :
IN THE COURT OF COMMON PLEAS OF THE 17TH JUDICIAL DISTRICT
OF PENNSYLVANIA SNYDER UNION COUNTY
BRANCH
OF THE DIVORCE CODE
_____________________________________________, (Address)
____________________________________________, (Address)
______________, (State) since __________________.(Date)
3. Plaintiff 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 Plaintiff 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. Plaintiff has been advised of the availability of counseling and the
Plaintiff may have the right to request the Court require the parties to
participate in counseling.
8. Plaintiff requests the Court to enter a decree of divorce.
DATED: ________________ _____________________________
Plaintiff
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.
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: __________________________
: : : : : : : :
IN THE COURT OF COMMON PLEAS OF THE 17TH JUDICIAL DISTRICT
OF PENNSYLVANIA SNYDER COUNTY BRANCH
CIVIL ACTION - LAW
I, _____________________, hereby depose and say that on this date, I
personally served the above captioned defendant, with a Complaint in Divorce
and Notice to Defend and Claim Rights with Notice of Availability of
Counseling, by personally handing the same to him/ her.
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:________________ __________________________
Plaintiff
_____________________, Plaintiff
vs.
______________________, Defendant
: : : : : : : :
IN THE COURT OF COMMON PLEAS OF THE 17TH JUDICIAL DISTRICT
OF PENNSYLVANIA SNYDER COUNTY BRANCH
CIVIL ACTION - LAW
I, _____________________, Defendant in the above- captioned action
depose and say that on this date, I hereby accept service of the Complaint in
Divorce and Notice to Defend and Claim Rights with Notice of Availability of
Counseling.
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:________________ _______________________ Defendant
: : : : : : : :
IN THE COURT OF COMMON PLEAS OF THE 17TH JUDICIAL DISTRICT
OF PENNSYLVANIA SNYDER COUNTY BRANCH
CIVIL ACTION - LAW
) ) )
1. On ______________ (date), a copy of the Complaint in Divorce
was mailed to the Defendant by Certified Mail, Return Receipt,
Deliver to Addressee Only, at the Defendant’s last known
address, as indicated on the attached mailing receipt.
2. That on ______________ (date), the Defendant received the
aforesaid Divorce Complaint and the mailing receipt and the
return receipt card evidencing the same are attached hereto and
made part hereof.
this ____ day of __________ 20__.
17TH JUDICIAL DISTRICT OF PENNSYLVANIA
SNYDER COUNTY BRANCH
AFFIDAVIT OF CONSENT
1. A Complaint in Divorce under §3301(c) of the Divorce Code was filed
on _____________________.
2. The marriage of the Plaintiff and Defendant is irretrievably broken and
ninety days have elapsed from the date of the 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 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:________________ _______________________ Plaintiff
17TH JUDICIAL DISTRICT OF PENNSYLVANIA
SNYDER COUNTY BRANCH
AFFIDAVIT OF CONSENT
1. A Complaint in Divorce under §3301(c) of the Divorce Code was filed
on _____________________.
2. The marriage of the Plaintiff and Defendant is irretrievably broken and
ninety days have elapsed from the date of the 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 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:________________ _______________________ Defendant
17TH JUDICIAL DISTRICT OF PENNSYLVANIA
SNYDER COUNTY BRANCH
CIVIL ACTION - LAW NO: ___________
WAIVER OF NOTICE OF INTENTION TO REQUEST ENTRY OF A DIVORCE DECREE UNDER §3301(c) and §3301 (d) 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 filed 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:________________ _______________________ Plaintiff
17TH JUDICIAL DISTRICT OF PENNSYLVANIA
SNYDER COUNTY BRANCH
CIVIL ACTION - LAW NO: ___________
WAIVER OF NOTICE OF INTENTION TO REQUEST ENTRY OF A DIVORCE DECREE UNDER §3301(c) and§3301 (d) 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
filed 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:________________ _______________________ Defendant
17TH JUDICIAL DISTRICT OF PENNSYLVANIA
SNYDER COUNTY BRANCH
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 Affidavit of Consent required by §3301(c)
of the Divorce Code:
By Plaintiff: __________________________
By Defendant: _________________________
b. 1) Date of execution of the Affidavit required by §3301(d) of the
Divorce Code:
________________________________________________
2.) Date of filing and service of the §3301 (d)Affidavit upon 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 intention to file praecipe,
a copy of which is attached:
________________________________________________
_______________________
_______________________
PLEAS OF THE 17TH JUDICIAL DISTRICT
OF PENNSYLVANIA SNYDER COUNTY BRANCH
CIVIL ACTION - LAW
Ordered and Decreed that _______________________________, Plaintiff, and
_____________________________, Defendant, are divorced from the bonds of
matrimony.
The court retains jurisdiction of any claims raised by the parties to this
action for which a final order has not yet been entered.
Any existing spousal support order shall hereafter be deemed an order
for alimony pendente lite if any economic claims remain pending.
BY THE COURT:
17TH JUDICIAL DISTRICT OF PENNSYLVANIA
SNYDER COUNTY BRANCH
PETITION FOR WAIVER OF COSTS
1. I am the Plaintiff 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 the fees and costs is true and correct:
(a) NAME:
EMPLOYER:
ADDRESS:
TYPE OF WORK:
DATE OF LAST EMPLOYMENT:
TYPE OF WORK:
BUSINESS OR PROFESSIONAL:
Name of person contributing:
EMPLOYER:
TYPE OF WORK:
MORTGAGE/RENT:
(g) PERSONS DEPENDENT UPON YOU FOR SUPPORT
CHILDREN, IF ANY: DO NOT USE MINOR CHILDREN’S NAME OR
DATES OF BIRTH ON ANY PAPERWORK, ONLY ON CONFIDENTIAL
FORM.
__CHILD #1___________________________________ ___________
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 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.
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: __________________________
17TH JUDICIAL DISTRICT OF PENNSYLVANIA
SNYDER COUNTY BRANCH
NOTICE OF INTENT TO RETAKE PRIOR NAME
A Divorce Complaint was filed on ____________________, 20 ____, in the above captioned matter. Notice is hereby given that Plaintiff/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 54 Pa. 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 seat this ______ day of _________________, 20 _____. _____________________________ (NOTARY)
_________________________________, PLAINTIFF vs. _________________________________, DEFENDANT
17TH JUDICIAL DISTRICT OF PENNSYLVANIA
SNYDER COUNTY BRANCH
AND NOW this ____ day of ____________________, 20____, upon review
of the Petition for Waiver of Costs, which establishes that the Plaintiff 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 Plaintiff is
permitted to proceed In Forma Pauperis, without prepayment of filing costs.
Parties permitted to proceed In Forma Pauperis must inform the 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 she believes the party is unable to pay the
cost; and the affidavit required by Pa.R.C.P. 240(d)(1)(ii).
BY THE COURT:
17TH JUDICIAL DISTRICT OF PENNSYLVANIA
SNYDER COUNTY BRANCH
NOTICE TO RESUME PRIOR SURNAME
_________________________
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)
_____________________, Plaintiff
vs.
______________________, Defendant
17TH JUDICIAL DISTRICT OF PENNSYLVANIA
SNYDER COUNTY BRANCH
NOTICE
If you wish to deny any of the statements set forth in this Affidavit, you must
file a Counter-affidavit within twenty (20) days after this Affidavit has been served on
you or the statements will be admitted.
AFFIDAVIT UNDER
The parties to this action separated on _________________ and have
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, lawyer’s fees or expenses if I do not claim them before a divorce is granted.
I verify that the statements made in this affidavit 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: ________________ _____________________ Plaintiff/ Defendant
Language Access Coordinator
Kelly Heeter 9 West Market St. Middleburg/ 103 S. Second St. Lewisburg
Snyder & 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/Español: Usted tiene derecho a un intérprete libre de costo. Para solicitar un intérprete favor de informárselo al personal judicial utilizando la información provista en la parte superior de este aviso.
Mandarin/Cantonese Simplified Chinese//:
/Arabic . :
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Russian/: . , . , . Vietnamese/Ting Vit: Quý v có quyn c mt thông dch viên giúp mà không tn chi phí nào c, xin hãy báo cho nhân viên tòa án dùng thông tin liên lc có trên u thông báo này.
Nepali/: ,
Korean/: .
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Polish/Polski: Ma Pan/Pani prawo do nieodpatnego skorzystania z usug tumacza ustnego. Aby zwróci si o wsparcie ze strony tumacza ustnego, prosz skontaktowa si z pracownikami sdu, korzystajc z danych znajdujcych si w górnej czci niniejszego dokumentu.
/Punjabi :Pakistan/
Punjabi/ /India: ,
, Portuguese/Português: Você tem direito a um intérprete gratuitamente. Para solicitar um intérprete, informe à nossa equipe usando os dados de contato mostrados na parte superior deste aviso. Somali/Somaali: Waxaad xaq u leedahay in lagu turjumo lacag la’aan ah. Si aad u codsato turjumaanka, fadlan u sheeg maxkamadda shaqaalaha adiga oo isticmaala macluumaadka ciwaanka kor lagu siiyay ee ogeysiiskaan. Haitian Creole/Kreyòl Ayisyen: Ou gen dwa resevwa sèvis yon entèprèt gratis. Pou mande pou yon entèprèt, tanpri fè manm pèsonèl tribinal la konnen lè ou sèvi avèk enfòmasyon an yo te bay ou nan tèt avi sa a. French/Français : Vous avez le droit de bénéficier gratuitement de l'assistance d'un interprète. Pour en faire la demande, veuillez en informer le personnel du tribunal à l’aide des coordonnées indiquées en haut de page.
PRINT CONFIDENTIAL FORM/DOCUMENTS AND DIRECTIONS
(if necessary)
COURT FILING OFFICE WITH OTHER FORMS.
COURT ADMIN/PROTHONOTARY NOTE: