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Prothonotary’s Office. They will keep the original and return the timestamped copies toyou. Serve a copy of the Affidavit of Separation and a blank Counter Affidavit, on yourspouse. You can mail these documents to your spouse through first class mail. Thencomplete and file a Certificate of Service with the Prothonotary.Your spouse has twenty (20) days to respond to the Affidavit of Separation. They wouldrespond by filing and serving you with the Counter-Affidavit.Notice of Intention and Praecipe to Transmit the RecordDo not start this step until twenty (20) days after you serve the Affidavit of Separation andCounter-affidavit. If your spouse does not respond within twenty (20) days, you will servethem with the Notice of Intention to File the Praecipe to Transmit Record along with anotherblank Counter Affidavit. You can mail these documents to your spouse through first classmail. Then complete and file a Certificate of Service with the Prothonotary. Now you mustwait another twenty (20) days to give your spouse a chance to respond.Wait at least twenty (20) days - if your spouse does not return the Counter-Affidavit orreturns the Counter-Affidavit and marks that they do not oppose the entry of a divorce youcan now ask the court to finalize the divorce. You will do this by filing the Praecipe toTransmit the Record and a blank Divorce Decree. Provide the court with self-addressed andstamped envelopes for you and your spouse so that the Court can mail you a copy of thefinal Divorce Decree.If your spouse returns the Counter-Affidavit and marks that they oppose the entry of adivorce and/or that they wish to file economic claims, the divorce cannot move forwarduntil everything is resolved. You may need to file a Motion for the Appointment of a DivorceMaster and prepare to go to court for a hearing. For more information, call an attorney atthe PA Safe Law Civil Legal Information Program (833-727-2335) or your local legalassistance office.Optional Step 5: Resume Prior SurnameComplete this step if you changed your last name when you got married and would like toreturn to a previous legal name. Fill out and file the Notice of Intent to Resume Prior Surnamewith the Prothonotary. It can be filed before or after the final Divorce Decree is granted. Theremay be a small fee for filing this form. NOTE: Before filing, make several copies of thedocument and sign each individually. When you file the Prothonotary’s office will timestampthese copies. You can then use those documents as proof of your name change withorganizations (social security, PennDOT, banks, etc.).Pennsylvania Coalition Against Domestic Violence LOCAL: 717.545.6400 / TOLL-FREE: 800.932.4632 PCADV.org Page 5 of 37

FORMSLIST OF DOCUMENTS1) Praecipe for Pro Se Entry of Appearance2)Notice to Defend3)Notice of Availability of Counseling4)Divorce Complaint5)Certificate of Compliance with the UJS Public Access Policy 26)Petition to Proceed in Forma Pauperis7)Affidavit of Personal Service8)Acceptance of Service9)Affidavit of Service by Mail10) Certificate of Service311) Praecipe to Reinstate the Divorce Complaint12) Affidavit of Consent13) Waiver of Notice of Intention to File the Praecipe to Transmit Record14) Affidavit of Separation under Section 3301(d) of the Divorce Code15) Counter-Affidavit 3301(d)16) Affidavit of Non-Military Service17) Notice of Intention to File the Praecipe to Transmit Record 3301(c)(1)18) Praecipe to Transmit the Record19) Divorce Decree20) Notice to Resume Prior Surname2Make sure to include this form with any document that you file at the Prothonotary’s Office. You can find moreinformation on the UJS Public Access Policy at this link.3 Except for the Divorce Complaint, you will include this form with any document that you file with the court todemonstrate you sent or gave a copy to your spouse.

,Plaintiffv.: In the Court of Common Pleas: County, Pennsylvania:: Docket No.,Defendant:: DivorcePRAECIPE FOR PRO SE ENTRY OF APPEARANCETO THE PROTHONOTARY:Please enter my appearance in the above-captioned matter as a self-represented party.I understand that I am under a continuing obligation to provide current contact information tothe court, to other self-represented parties, and to attorneys of record. All pleadings and legalpapers can be served on me at the address listed below, which may or may not be my homeaddress pursuant to Pa.R.C.P. 1930.8.Respectfully submitted,Dated:Printed NameSignatureAddressCity, State, Zip Code

,Plaintiff: In the Court of Common Pleas: County, Pennsylvaniav.:: Docket No.,Defendant:: DivorceNOTICE TO DEFENDYOU HAVE BEEN SUED IN COURT. If you wish to defend against the claims set forthin the following pages, you must take prompt action. If you fail to do so, the case may proceedwithout you and a decree of divorce or annulment may be entered against you by the court. Ajudgement may also be entered against you for any other claim or relief requested in thesepapers by the plaintiff. You may lose money or property or other rights important to you,including custody of your children.When the ground of divorce is indignities or irretrievable breakdown of marriage, youmay request marriage counseling, a list of marriage counselors is available in the office of theProthonotary at: .If you do not file a claim for alimony, division of property, lawyers’ fees or expensesbefore 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 HAVEA LAWYER, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW. THIS OFFICE CANPROVIDE YOU WITH INFORMATION ABOUT HIRING A LAWYER. IF YOU CANNOT AFFORDTO HIRE A LAWYER, THIS OFFICE MAY BE ABLE TO PROVIDE YOU WITH INFORMATIONABOUT AGENCIES THAT MAY OFFER LEGAL SERVICES TO ELIGIBLE PERSONS AT AREDUCED FEE OR NO FEE.

,Plaintiffv.: In the Court of Common Pleas: County, Pennsylvania:: Docket No.,Defendant:: DivorceNOTICE OF AVAILABILITY OF COUNSELINGYou are one of the parties in the above-captioned action in divorce. Pursuant to 23Pa.C.S. §3302, whenever indignities, irretrievable breakdown with mutual consent orirretrievable breakdown of the marriage after one-year separation are ground(s) for the divorceunder Section 3301 (a), (b), (c) or (d) of the Divorce Code, counseling may be available to theparties upon request. However, the Court may not order counseling over the objection of aparty that has an enforceable protection from abuse order against the other party, or wherethe objecting party was a victim of a personal injury crime for which the other party wasconvicted or has entered into an Accelerated Rehabilitative Disposition program.Accordingly, if you desire counseling, please contact the Prothonotary’s office at thelocal county courthouse for a list of qualified professionals.

,Plaintiffv.: In the Court of Common Pleas: County, Pennsylvania:: Docket No.,Defendant:: DivorceCOMPLAINT FOR DIVORCE UNDERSECTION 3301(c) or 3301(d) OF THE DIVORCE CODE1.Plaintiff is , (Name) who currently resides at, (Address) , (City)(County) (State) since . (Date)2.Defendant is , (Name) who currently resides at, (Address) , (City)(County) (State) since . (Date)3.Plaintiff has been a bona fide resident of the Commonwealth of Pennsylvania forat least six months immediately prior to the filing of this Complaint.4.Plaintiff and Defendant were married on (Date) at(City) (State/County).5.There have been no prior actions of divorce or for annulment between theparties.6.The marriage is irretrievably broken.7.Plaintiff has been advised that counseling is available and that Plaintiff may havethe right to request that the court require the parties to participate in counseling.

8.Plaintiff requests the court to enter a decree of divorce.I verify that the statements made in this Complaint are true and correct. I understandthat false statements herein are made subject to the penalties of 18 Pa.C.S. §4904 relating tounsworn falsification to authorities.Respectfully submitted,Dated:Printed NameSignatureAddressCity, State, Zip Code

,Plaintiffv.: In the Court of Common Pleas: County, Pennsylvania:: Docket No.,Defendant:: DivorceCERTIFICATE OF COMPLIANCEI certify that this filing complies with the provisions of the Case Records Public AccessPolicy of the Unified Judicial System of Pennsylvania that require filing confidentialinformation and documents differently than non-confidential information and documents.Submitted by:Signature:Name:Attorney No. (if applicable):

,Plaintiffv.: In the Court of Common Pleas: County, Pennsylvania:: Docket No.,Defendant:: DivorcePETITION TO PROCEED IN FORMA PAUPERIS1.I am the plaintiff in the above matter and because of my financial condition amunable 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, topay the costs of litigation.3.I represent that the information below relating to my ability to pay the fees andcosts is true and correct:a.b.c.If Employedi.Name of Employer:ii.Address of Employer:iii.Salary/Wage:iv.Type of Work:If Unemployedi.Date of Last Employment:ii.Name of Employer:iii.Address of Employer:iv.Salary/Wage:v.Type of Work:Other Income in the Last 12 Monthsi.Self-Employment Income:ii.Interest:iii.Dividends:

d.e.f.iv.Pension and/or Annuities:v.Social Security Benefits:iv.Support Payments:v.Disability Payments:vi.Unemployment Compensation:vii.Worker’s Compensation:viii.Public Assistance:ix.Other:Other Contributions to Household Supporti.Spouse’s Name:ii.Spouse’s Employer:iii.Spouse’s Salary/Wage:iv.Type of Work:v.Contributions from Parents:vi.Contributions from Children:vii.Other Contributions:Property Ownedi.Cash:ii.Checking Account:iii.Savings Account:iv.Certificates of Deposit:v.Real Estate:vi.Motor Vehicle:vii.Stocks and Bonds:viii.Other:Debts and Obligationsi.Mortgage:ii.Rent:iii.Loans:

iv.g.4.Other:Persons Dependent Upon You for Supporti.Spouse:ii.Child(ren):I understand that I have a continuing obligation to inform the court ofimprovement in my financial circumstances which would permit me to pay the costs incurredherein.5.I verify that the statements made in this affidavit are true and correct. Iunderstand that false statements herein are made subject to the penalties of 18 Pa.C.S. §4904,relating to unsworn falsification to authorities.Respectfully submitted,Dated:Printed NameSignatureAddressCity, State, Zip Code

,Plaintiffv.: In the Court of Common Pleas: County, Pennsylvania:: Docket No.,Defendant:: DivorceAFFIDAVIT OF SERVICE BY PERSONAL SERVICEPursuant to 1930.4I, , hereby depose and say that I am 18 years or older,and am not a party to the action, nor an employee or relative of a party.On I personally served the defendant by handing to them a:X Complaint in Divorce, Notice to Defend and Claim Rights, and Notice of Availabilityof Counseling.I verify that the statements in this document are true and correct to the best of my knowledge,information, and belief. I understand that false statements herein are made subject to thepenalties of 18 Pa.C.S. §4904, relating to unsworn falsification to authorities.Respectfully submitted,Date:Signature of Person who Served Defendant(Not Plaintiff)

,Plaintiffv.: In the Court of Common Pleas: County, Pennsylvania:: Docket No.,Defendant:: DivorceACCEPTANCE OF SERVICEI hereby affirm that I have accepted service of the Complaint in Divorce in the abovecaptioned matter. I understand that false statements herein are made subject to the penaltiesof 18 Pa.C.S. §4904, relating to unsworn falsification to authorities.Respectfully submitted,Dated:Printed NameSignatureAddressCity, State, Zip Code

,Plaintiffv.: In the Court of Common Pleas: County, Pennsylvania:: Docket No.,Defendant:: DivorceAFFIDAVIT OF SERVICE BY MAIL PURSUANT TO PA.R.CIV.P1920.4, being duly sworn according to law,deposes and says that they representing themselves pro se, mailed a copy of the Complaintin Divorce filed in this matter by certified mail, return receipt requested, addressee only, tothe Defendant at ,on , 20 .[Check one below][ ]The return receipt signed by the Defendant is evidence of delivery to them and isattached hereto along with the Certified Mail receipt as Exhibit “B.”[ ]The Defendant refused to sign the receipt. However, Defendant was also served viaregular mail and said regular mail was not returned within fifteen (15) days. The CertifiedMail receipt and Certificate of Mailing for regular mail is attached hereto as Exhibit “B.”Respectfully submitted,Dated:Printed NameSignatureAddressCity, State, Zip Code

,Plaintiff: In the Court of Common Pleas: County, Pennsylvaniav.:: Docket No.,Defendant:: DivorceCERTIFICATE OF SERVICEI hereby certify that on this date, I did serve a true and correct copy of the foregoingdocument upon Defendant via first class U.S. Mail addressed as follows:Respectfully submitted,Dated:Printed NameSignatureAddressCity, State, Zip Code

,Plaintiffv.: In the Court of Common Pleas: County, Pennsylvania:: Docket No.,Defendant:: DivorcePRAECIPE TO REINSTATE THE DIVORCE COMPLAINTTO THE PROTHONOTARY:Please reinstate the Divorce Complaint filed in the above-captioned matter on.Respectfully submitted,Dated:Printed NameSignatureAddressCity, State, Zip Code

,Plaintiffv.: In the Court of Common Pleas: County, Pennsylvania:: Docket No.,Defendant:: DivorceAFFIDAVIT OF CONSENT1.A Complaint in Divorce pursuant to Section 3301(c) of the Divorce Code wasfiled on , 20 and served on the defendant on , 20 .2.The marriage of Plaintiff and Defendant is irretrievably broken and 90 days haveelapsed from the date of filing and service of the Complaint.3.I consent to the entry of a final decree of divorce after service of the Notice ofIntention to File Praecipe to Transmit Record.I verify that the statements made in this affidavit are true and correct. I understand thatfalse statements herein are made subject to the penalties of 18 Pa.C.S. §4904 relating tounsworn falsification to authorities.Respectfully submitted,Dated:Printed NameSignatureAddressCity, State, Zip Code

,Plaintiffv.: In the Court of Common Pleas: County, Pennsylvania:: Docket No.,Defendant:: DivorceWAIVER OF NOTICE OF INTENTION TO FILE THE PRAECIPE TO TRANSMIT RECORD1.Without further notice, I consent to the entry of:[ ] a final decree of divorce; or[ ] an order approving grounds for divorce.2. I understand that I may lose rights concerning alimony, equitable division of property,lawyer’s fees, costs and expenses, or other important rights if I do not claim them before adivorce is granted.3. I understand that I will not be divorced until a divorce decree is entered by the Court andthat a copy of the decree will be sent to me immediately after it is filed.I verify that the statements made in this affidavit are true and correct. I understand that falsestatements herein are made subject to the penalties of 18 Pa.C.S. § 4904 relating to unswornfalsification to authorities.Respectfully submitted,Dated:Printed NameSignatureAddressCity, State, Zip Code

,Plaintiffv.: In the Court of Common Pleas: County, Pennsylvania:: Docket No.,Defendant:: DivorceNOTICEIf you wish to deny any of the statements set forth in this affidavit, you must file a counteraffidavit within twenty days after this affidavit has been served on you or the statements will beadmitted.AFFIDAVIT OF SEPARATION UNDER §3301(d) OF THE DIVORCE CODE1.The parties to this action separated on ,20 .2.Check (a) or (b):(a) The date of separation was prior to December 5, 2016, and the partieshave continued to live separate and apart for a period of at least two years.(b) The date of separation was on or after December 5, 2016, and the partieshave continued to live separate and apart for a period of at least one year.3.The marriage is irretrievably broken.4.I understand that I may lose rights concerning alimony, division of property,lawyer’s fees, costs and expenses, or other important rights if I do not claim thembefore a divorce is granted.

I verify that the statements made in this affidavit are true and correct. I understand thatfalse statements herein are made subject to the penalties of 18 Pa.C.S. §4904 relating tounsworn falsification to authorities.Respectfully submitted,Dated:Printed NameSignatureAddressCity, State, Zip Code

,Plaintiffv.: In the Court of Common Pleas: County, Pennsylvania:: Docket No.,Defendant:: DivorceCOUNTER-AFFIDAVIT UNDER §3301(d) OF THE DIVORCE CODE1.Check either (a) or (b):(a) I do not oppose the entry of a divorce decree.(b) I oppose the entry of a divorce decree because:(Check (i), (ii), (iii) or all):(i) The parties to this action have not lived separate and apart for therequired separation period: two years for parties that separated prior toDecember 5, 2016, and one year for parties that separated on or afterDecember 5, 2016.(ii) The marriage is not irretrievably broken.(iii) There are economic claims pending.2.Check (a), (b) or (c):(a) I do not wish to make any claims for economic relief. I understand that Imay lose rights concerning alimony, division of property, lawyer’s fees orexpenses if I do not claim them before a divorce is granted.(b) I wish to claim economic relief which may include alimony, division ofproperty, lawyer’s fees or expenses or other important rights.I UNDERSTAND THAT IN ADDITION TO CHECKING (b) ABOVE, I MUST ALSO FILE ALL OF MYECONOMIC CLAIMS WITH THE PROTHONOTARY IN WRITING AND SERVE THEM ON THEOTHER PARTY. IF I FAIL TO DO SO BEFORE THE DATE SET FORTH ON THE NOTICE OFINTENTION TO REQUEST DIVORCE DECREE, THE DIVORCE DECREE MAY BE ENTERED

WITHOUT FURTHER NOTICE TO ME, AND I SHALL BE UNABLE THEREAFTER TO FILE ANYECONOMIC CLAIMS.(c) Economic claims have been raised and are not resolved.I verify that the statements made in this counter-affidavit are true and correct. Iunderstand that false statements herein are made subject to the penalties of 18 Pa.C.S. §4904relating to unsworn falsification to authorities.Respectfully submitted,Dated:Printed NameSignatureAddressCity, State, Zip CodeNOTICE: IF YOU DO NOT WISH TO OPPOSE THE ENTRY OF A DIVORCE DECREE AND YOUDO NOT WISH TO MAKE ANY CLAIM FOR ECONOMIC RELIEF, YOU SHOULD NOT FILE THISCOUNTER-AFFIDAVIT.

,Plaintiffv.: In the Court of Common Pleas: County, Pennsylvania:: Docket No.,Defendant:: DivorceAFFIDAVIT OF NON-MILITARY SERVICEI, say that I am the Plaintiff in the abovecaptioned matter and that I personally know that the above-captioned Defendant is over theage of eighteen years, and that the Defendant is not in the military service or any branch ofthe armed forces of the United States or its allies or otherwise within the provisions of theServicemembers’ Civil Relief Act, formally the Soldiers’ and Sailors’ Civil Relief Act ofCongress of 1940, and amendments thereto.I verify that the statements made in this Affidavit of Non-Military Service are true andcorrect. I understand that false statements herein are made subject to the penalties of 18Pa.C.S. §4904 relating to unsworn falsification to authorities.Respectfully submitted,Dated:Signature

,Plaintiff: In the Court of Common Pleas: County, Pennsylvaniav.:: Docket No.,Defendant:: DivorceNOTICE OF INTENTION TO FILETHE PRAECIPE TO TRANSMIT RECORDUNDER SECTION 3301(c)(1) OF THE DIVORCE CODETO:(Defendant)You have signed an Affidavit of Consent under Section 3301(c) of the Divorce Codeconsenting to the entry of a divorce decree. Therefore, on or after , 20 ,the other party can request the court to enter a final decree in divorce or, if there are unresolvedancillary claims, an order approving grounds for divorce as indicated on the proposedPraecipe to Transmit Record, which is attached.Unless you have already filed with the court a written claim for economic relief, you mustdo so by the date in the paragraph above, or the court may grant the divorce or, if there areunresolved ancillary claims, an order approving grounds for divorce and you may lose foreverthe right to ask for economic relief. Th

divorce, you must wait 90 days before taking the next step. See Step 4a. If the divorce is an irretrievable breakdown divorce because your spouse does not agree to the divorce, you must be separated for 1 year before moving forward with finalizing the divorce. See Step 4b. Step 4a: Mutual Consent Divorce - 3301(c)