Fraudulent Conveyance Quiet Title Packet

Embed Size (px)

Citation preview

  • 8/9/2019 Fraudulent Conveyance Quiet Title Packet

    1/22

    Quiet Title

    An action to quiet title is a lawsuit brought in a court havingjurisdiction over

    land disputes, in order to establish a party's title to real property against anyone

    and everyone, and thus "quiet" any challenges or claims to the title. It comprises

    a complaint that the ownership (title) of a parcel of land or other real property is

    defective in some fashion, typically where title to the property is ambiguous. A

    typical ground for complaint includes the fraudulent conveyance of a property,

    perhaps by a forged deed or under coercion.

    Unlike acquisition through a deed of sale, a quiet title action will give the party

    seeking such relief no cause of action against previous owners of the property.

  • 8/9/2019 Fraudulent Conveyance Quiet Title Packet

    2/22

    DEFENDANT'S NAMEPLAINTIFF'S NAME

    PLAINTIFF'S ADDRESS DEFENDANT'S ADDRESS

    PLAINTIFF'S NAME DEFENDANT'S NAME

    PLAINTIFF'S ADDRESS DEFENDANT'S ADDRESS

    AMOUNT IN CONTROVERSY

    STATUTORY BASIS FOR CAUSE OF ACTION (SEE INSTRUCTIONS)

    RELATED PENDING CASES (LIST BY CASE CAPTION AND DOCKET NUMBER)

    PHONE NUMBER

    ADDRESS (SEE INSTRUCTIONS)NAME OF PLAINTIFF'S/PETITIONER'S/APPELLANT'S ATTORNEY

    FAX NUMBER

    For Prothonotary Use Only (Docket Number)Court of Common Pleas of Philadelphia County

    Trial Division

    Civil Cover Sheet

    COMMENCEMENT OF ACTIONTOTAL NO. OF DEFENDANTS

    $50,000.00 or less

    More than $50,000.00

    Complaint Petition Action Notice of Appeal

    Writ of Summons Transfer From Other Jur isdicti ons

    TOTAL NUMBER OF PLAINTIFFS

    CASE TYPE AND CODE (SEE INSTRUCTIONS)

    Yes No

    IS CASE SUBJECT TO

    COORDINATION ORDER?

    SUPREME COURT IDENTIFICATION NO. E-MAIL ADDRESS

    DATESIGNATURE

    PLAINTIFF'S NAME DEFENDANT'S NAME

    PLAINTIFF'S ADDRESS DEFENDANT'S ADDRESS

    TO THE PROTHONOTARY:

    Kindly enter my appearance on behalf of Plaintiff/Petitioner/Appellant:

    Papers may be served at the address set forth below.

    COURT PROGRAMS

    Arbitration Mass Tort Commerce Settlement

    Jury Savings Action Minor Court Appeal Minors

    Non-Jury Petition Statutory Appeals W/D/Survival

    Other:

  • 8/9/2019 Fraudulent Conveyance Quiet Title Packet

    3/22

    Instructions for Completing Civil Cover Sheet

    Rules of Court require that a Civil Cover Sheet be attached to any document commencing an action (whether the action is commenced by Complain

    Writ of Summons, Notice of Appeal, or by Petition). The information requested is necessary to allow the Court to properly monitor, control a

    dispose cases filed. A copy of the Civil Cover Sheet must be attached to service copies of the document commencing an action. The attorney or no

    represented party filing a case shall complete the form as follows:

    A. Part ies

    i. Plaintiffs/Defendants

    Enter names (last, first, middle initial) of plaintiff, petitioner or appellant ("plaintiff") and defendant. If the plaintiff or defendant is

    government agency or corporation, use the full name of the agency or corporation. In the event there are more than three plaintiffs and/three defendants, list the additional parties on the Supplemental Parties Form. Husband and wife are to be listed as separate parties.

    ii. Parties' Addresses

    Enter the address of the parties at the time of filing of the action. If any party is a corporation, enter the address of the registered office

    the corporation.

    iii. Number of Plaintiffs/Defendants: Indicate the total number of plaintiffs and total number of defendants in the action.

    B . Commencement Type: Indicate type of document filed to commence the action.

    C. Amount in Controversy : Check the appropriate box.

    D . C ou rt P ro gr am : Check the appropriate box.

    E. Case Types: Insert the code number and type of action by consulting the list set forth hereunder. To perfect a jury trial, the appropriate fees mu

    be paid as provided by rules of court.

    F. C om me rc e Pr og ra mCommencing January 3, 2000 the First Judicial District instituted a Commerce Program for cases involving corporations and corporate law issues,

    general. If the action involves corporations as litigants or is deemed a Commerce Program case for other reasons, please check this block AND compl

    the information on the "Commerce Program Addendum". For further instructions, see Civil Trial Division Administrative Docket 01 of 1999.

    G. Statutory Basis for Cause of Act ion

    If the action is commenced pursuant to statutory authority ("Petition Action"), the specific statute must be identified.

    H . R e la te d P e nd i ng C as e s

    All previously filed related cases, regardless of whether consolidated by Order of Court or Stipulation, must be identified.

    I. P la in ti ff 's A tt or ne y

    The name of plaintiff's attorney must be inserted herein together with other required information. In the event the filer is not represented by

    attorney, the name of the filer, address, the phone number and signature is required.

    The current version of the Civil Cover Sheet may be downloaded from the FJD's website

    http://courts.phila.gov01-101 (Rev. 2/00) (Reverse)

    Proceedings Commenced by AppealMinor Court

    5M Money Judgment5L Landlor d and Tenant5D Denial Open Default Judgment5 E C od e En fo rc em en t

    Other:Local Agency

    5B Motor Vehicle Suspension -Breathalizer

    5V Motor Vehicle Licenses,Inspections, Insurance

    5C Civil Se rv ice5K Philadelphia Parking Authori ty5Q Liquor Control Board5R Board of Revision of Taxes5X Tax Assessment Boards

    5 Z Z on in g B oa rd5 2 Bo ard of View5 1 Other:

    Other:

    Proceedings Commenced by Petition8P Appointment of Arbitrators8C Name Change - Adult8L Compel Medical Examination8 D E mi ne nt Do ma in8 E E le ct io n M at te rs8F Forfei ture8S Leave to Issue Subpoena8M Mental Health Proceedings

    8G Civil Tax Case - Petition

    Other:

    Contract

    1C Contract

    1 T C on st ru ct io n

    1O Other:

    Tort

    2B Assault and Battery

    2L Libel and Slander

    4F Fraud

    1J Bad Faith

    2E Wrongful Use of Civil Process

    Other:

    Negligence

    2V Motor Vehicle Accident

    2H Other Traffic Accident

    1F No Fault Benefits

    4M Motor Vehicle Property Damage2F Personal Injury - FELA

    2O Other Personal Injury

    2S Premises Liability - Slip & Fall

    2P Product Liabili ty

    2 T To xi c Tort

    T1 Asbestos

    TZ DE S

    T2 Implant

    3E Toxic Waste

    Other:

    Actions Commenced by Writ of Summons or ComplaintProfessional Malpractice

    2 D Dental

    4 L Legal

    2 M Medical

    4 Y Other:

    1G Subrogation

    Equity

    E1 No Real Estate

    E2 Rea l Estate

    1D Declaratory Judgment

    M1 Mandamus

    Real Property

    3R Rent, Lease, Ejectment

    Q 1 Quie t T it le

    3F Mortgage Foreclosure

    1L Mechanics LienP 1 Partition

    Prevent Waste

    1V Replevin

    1H Civil Tax Case - Complaint

    Other:

  • 8/9/2019 Fraudulent Conveyance Quiet Title Packet

    4/22

    1

    NAME OF FILING PARTY:

    ___________________________________Name

    ___________________________________Address

    ___________________________________City, State, Zip

    ___________________________________Telephone

    THIS IS NOT AN

    ___________________________________ ARBITRATION CASE

    ______________________________ : PHILADELPHIA COUNTY

    : COURT OF COMMON PLEAS

    ______________________________ : TRIAL DIVISION - CIVILPlaintiff :

    :

    vs. : _________ TERM, _____________

    :Month Year

    ______________________________ :

    : No. ________________________

    ______________________________ :Defendant :

    ACTION TO QUIET TITLE

    (FRAUDULENT CONVEYANCE)

    NOTICE

    You have been sued in court. If you wish to defend against theclaims set forth in the following pages, you must take action withintwenty (20) days after the complaint and notice are served, by entering awritten appearance personally or by attorney and filing in writing with thecourt your defenses or objections to the claims set forth against you.You are warned that if you fail to do so the case may proceed withoutyou and a judgment may be entered against you by the court withoutfurther notice for any money claimed in the complaint or for any otherclaim or relief requested by plaintiff. You may lose money or property orother rights important to you.

    YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER ATONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD

    ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TOFIND OUT WHERE YOU CAN GET LEGAL HELP.

    PHILADELPHIA BAR ASSOCIATIONLawyer Referral and Information Service

    1101 Market Street, 11th FloorPhiladelphia, Pennsylvania 19107

    (215) 238-1701

    AVISO

    Le han demandado a usted en la corte. Si usted quieredefenderse de estas demandas expuestas en las pginas siguientes,usted tiene veinte (20) dias de plazo al partir de la fecha de la demanday la notificatin. Hace falta asentar una comparencia escrita o enpersona o con un abogado y entregar a la corte en forma escrita susdefensas o sus objeciones a las demandas en contra de su persona.Sea avisado que si usted no se defiende, la corte tomar medidas ypuede continuar la demanda en contra suya sin previo aviso onotificacin. Adems, la corte puede decider a favor del demandante yrequiere que usted cumpla con todas las provisiones de esta demanda.Usted puede perder dinero o sus propiedades u otros derechosimportantes para usted.

    LLEVE ESTA DEMANDA A UN ABOGADO INMEDIATAMENTE.SI NO TIENE ABOGADO O SI NO TIENE EL DINERO SUFICIENTEDE PAGAR TAL SERVICIO, VAYA EN PERSONA O LLAME PORTELEFONO A LA OFICINA CUYA DIRECCION SE ENCUENTRAESCRITA ABAJO PARA AVERIGUAR DONDE SE PUEDECONSEGUIR ASISTENCIA LEGAL.

    ASOCIACIN DE LICENCIADOS DE FILADELFIAServicio De Referencia E Informacin Legal

    1101 Market Street, 11th FloorFiladelfia, Pennsylvania 19107

    (215) 238-1701

  • 8/9/2019 Fraudulent Conveyance Quiet Title Packet

    5/22

    2

    NAME OF FILING PARTY:

    ___________________________________Name

    ___________________________________Address

    ___________________________________City, State, Zip

    ___________________________________Telephone

    THIS IS NOT AN

    ___________________________________ ARBITRATION CASE

    ______________________________ : PHILADELPHIA COUNTY

    : COURT OF COMMON PLEAS

    ______________________________ : TRIAL DIVISION - CIVILPlaintiff :

    :

    vs. : _________ TERM, _____________

    :Month Year

    ______________________________ :

    : No. ________________________

    ______________________________ :Defendant :

    ACTION TO QUIET TITLE

    (FRAUDULENT CONVEYANCE)

    Plaintiff, hereby files this Complaint against the Defendant to Quiet Title with

    respect to a certain parcel of real estate and in support thereof avers as follows:

    1. Plaintiff(s) is/are:_______________________________________________________________

    _______________________________________________________________

    2. Defendant(s) is/are:_______________________________________________________________

    _______________________________________________________________

  • 8/9/2019 Fraudulent Conveyance Quiet Title Packet

    6/22

    3

    3. The real estate, which is the subject of this litigation is:_______________________________________________________________

    _______________________________________________________________

    ______________________________________________________________.

    A copy of the legal description is contained within the deed conveying the

    property to the Plaintiff, which is attached hereto.

    4. State the cause of action in detail:_______________________________________________________________

    _______________________________________________________________

    _______________________________________________________________

    _______________________________________________________________

    _______________________________________________________________

    _______________________________________________________________

    _______________________________________________________________

    _______________________________________________________________

    _______________________________________________________________

    _______________________________________________________________

    _______________________________________________________________

    _______________________________________________________________

    _______________________________________________________________

    _______________________________________________________________

    _______________________________________________________________

  • 8/9/2019 Fraudulent Conveyance Quiet Title Packet

    7/22

    4

    WHEREFORE, Plaintiff respectfully requests that this Honorable Court find in

    his/her favor and against the Defendant(s), and enter a judgment ordering the Recorder of

    Deeds for Philadelphia County to convey the property located at:

    ________________________________________________________________________

    ________________________________________________________________________

    ________________________________________________________________________

    to the Plaintiff(s), upon presentment of an order stating the same; and granting such other

    relief as is necessary and appropriate.

    Respectfully submitted:

    __________________________________

    Plaintiff

    ___________________________________

    Plaintiff

    Date: _______________________

  • 8/9/2019 Fraudulent Conveyance Quiet Title Packet

    8/22

    5

    NAME OF FILING PARTY:

    ___________________________________Name

    ___________________________________Address

    ___________________________________City, State, Zip

    ___________________________________Telephone

    ___________________________________

    ______________________________ : PHILADELPHIA COUNTY

    : COURT OF COMMON PLEAS

    ______________________________ : TRIAL DIVISION - CIVILPlaintiff :

    :

    vs. : _________ TERM, _____________

    :Month Year

    ______________________________ :

    : No. ________________________

    ______________________________ :Defendant :

    AFFIDAVIT OF PLAINTIFF

    COMMONWEALTH OF PENNSYLVANIA :

    : ss.

    COUNTY OF PHILADELPHIA :

    I, _____________________________ (Plaintiff), being duly sworn according to

    law, depose and say that the facts stated herein are true and correct.

    ________________________________Plaintiff

    __________________________________

    Plaintiff

  • 8/9/2019 Fraudulent Conveyance Quiet Title Packet

    9/22

    6

    VERIFICATION

    Plaintiff(s)_________________________________________________________

    ________________________________________________________________________

    hereby verify that the statements set forth in the foregoing Complaint are true and correct

    to the best of my knowledge, information, and belief; I understand that these statements

    are made subject to the penalties of 18 Pa.C.S. 4904, relating to unsworn falsification to

    authorities.

    _________________________________

    Signature of Plaintiff

    __________________________________Signature of Plaintiff

    Dated: _____________________

  • 8/9/2019 Fraudulent Conveyance Quiet Title Packet

    10/22

    PHILADELPHIA COURT OF COMMON PLEAS

    PETITION/MOTION COVER SHEET

    vs .

    Term,

    No.

    Name of Filing Party:

    (Check one) Plaintiff Defendant

    (Check one) Movant Respondent

    Has another petition/motion been decided in this case? Yes No

    Is another petition/motion pending? Yes No

    If the answer to either question is yes, you must identify the judge(s):

    FOR COURT USE ONLY

    ASSIGNED TO JUDGE:

    Do not send Judge courtesy copy of Petition/Motion/Answer/Response.

    Status may be obtained online at http://courts.phila.gov

    Month Year

    INDICATE NATURE OF DOCUMENT FILED:

    Petition (Attach Rule to Show Cause) Motion

    Answer to Petition Response to Motion

    I. CASE PROGRAM

    Is this case in the (answer all questions):

    A. COMMERCE PROGRAM

    Name of Judicial Team Leader:

    Applicable Petition/Motion Deadline:

    Has deadline been previously extended by the Court?

    Yes No

    B. DAY FORWARD/MAJOR JURY PROGRAM YearName of Judicial Team Leader:

    Applicable Petition/Motion Deadline:

    Has deadline been previously extended by the Court?

    Yes No

    C . NON JURY PROGRAM

    Date Listed:

    D. ARBITRATION PROGRAM

    Arbitration Date:

    E. ARBITRATION APPEAL PROGRAM

    Date Listed:

    F. OTHER PROGRAM:

    Date Listed:

    II. PARTIES

    (Name, address and telephone number of all counsel of record andunrepresented parties. Attach a stamped addressed envelope for each

    attorney of record and unrepresented party.)

    TYPE OF PETITION/MOTION (see list on reverse side)

    MOTION TO PROCEED IN FORMA PAUPERIS

    PETITION/MOTION CODE

    (see list on reverse side)

    MTIFP

    III. OTHER

    30-1061A (Rev. 7/05)

    By filing this document and signing below, the moving party certifies that this motion, petition, answer or response along with all documents filed

    will be served upon all counsel and unrepresented parties as required by rules of Court (see PA. R.C.P. 206.6, Note to 208.2(a), and 440). Furthermore

    moving party verifies that the answers made herein are true and correct and understands that sanctions may be imposed for inaccurate or incomplete

    answers.

    (Attorney Signature/Unrepresented Party) (Date) (Print Name) (Attorney I.D. No.)

    The Petition, Motion and Answer or Response, if any, will be forwarded to the Court after the Answer/Response Date.No extension of the Answer/Response Date will be granted even if the parties so stipulate.

    CONTROL NUMBER:

    (RESPONDING PARTIES MUST INCLUDE THIS

    NUMBER ON ALL FILINGS)ANSWER/RESPONSE DATE:

    ANSWER/RESPONSE FILED TO (Please insert the title of the corresponding petition/motion to which you areresponding):

    MOTION TO PROCEED IN FORMA PAUPERIS

  • 8/9/2019 Fraudulent Conveyance Quiet Title Packet

    11/22

    Instructions for completing

    Petition to Proceed

    In Forma Pauperis

    1. All blanks and all questions MUST be filled in or answered.Dollar amounts MUST be clearly stated where requested.

    2. A copy of your latest Pennsylvania tax or federal tax return

    should be attached.

    3. Service of a copy of this petition MUST be made on the

    opposing party or opposing partys attorney.

    4. Please attach a self-addressed, stamped envelope for

    yourself and an addressed, stamped envelope for each

    opposing party or opposing partys attorney.

    5. Petitioner is required to have the enclosed Affidavit notarized

    by a licensed Notary Public.

    6. Your petition may be dismissed or denied for failure toproperly complete all information.

    Definition of Terms:

    Affidavit: A voluntary declaration of facts written down and sworn to by the declarant before an

    officer authorized to administer oaths.

    Defendant: A person who is sued in a civil or criminal proceeding.

    In Forma Pauperis: [Latin in the manner of a pauper] To proceed in the manner of anindigent who is permitted to disregard filing fees and court costs.

    Petitioner: A party who presents a petition to a court or other official body.

    Plaintiff: The party who brings a civil suit in a court of law against another person or entity.

  • 8/9/2019 Fraudulent Conveyance Quiet Title Packet

    12/22

    First Judicial District of PennsylvaniaCourt of Common Pleas of Philadelphia County

    Civil Trial Division

    ___________________________________, pro se (your name)

    ___________________________________

    ___________________________________ (full address)

    ___________________________________(area code and telephone number)

    ___________________________________ : _____________________Term, 20_________: (month) (year)

    ___________________________________ :Plaintiff(s) :

    :VS. :

    ::

    ___________________________________ ::

    ___________________________________ : NO._________________________________Defendant(s)

    In Forma Pauperis Order

    AND NOW, this ____________day of ________________________, 20_______ , it is

    hereby ORDERED AND DECREED that:

    1. Petitioner be permitted to proceed without paying the costs of this proceeding or

    posting a bond.

    2. Petitioner be permitted to obtain service of the papers filed without cost.

    3. Petitioner be permitted to proceed in forma pauperis as to any additional costs

    which accrue in the course of this proceeding.

    (IFP/REV.10/2000)

  • 8/9/2019 Fraudulent Conveyance Quiet Title Packet

    13/22

    Page 2 of 11

    Cour t Term________________20____and No.___________

    4. If there is a monetary recovery by judgment or settlement in favor of the party

    permitted to proceed in forma pauperis, the exonerated fees and costs shall be taxed as costs

    and paid to the Prothonotary by the party paying the monetary recovery.

    5. Petitioner has a continuing obligation to inform the Court of any improvement in partys

    financial circumstances that will enable the party to pay costs.

    BY THE COURT:

    ________________________________________

    J.

  • 8/9/2019 Fraudulent Conveyance Quiet Title Packet

    14/22

    Page 3 of 11

    First Judicial District of PennsylvaniaCourt of Common Pleas of Philadelphia County

    Civil Trial Division

    __________________________________, pro se(your name)

    __________________________________

    __________________________________(full address)

    __________________________________(area code and telephone number)

    __________________________________ : ___________________, TERM, 20 ______: (month) (year):

    __________________________________ :Plaintiff(s) :

    :VS. :

    :_____________________________ :

    :_____________________________ :

    Defendant(s) : NO. _____________________________

    Petition to Proceed In Forma Pauperisand Without Payment of Bond

    TO THE HONORABLE, THE JUDGES OF SAID COURT:

    Petitioner, (your name) _________________________________________, seeks(please print your name)

    leave to proceed in this matter in forma pauperis, and respectfully represents that:

    1. I am the (indicate plaintiff or defendant) __________________________ in these

    proceedings.

    Court Term__________________20____and No. ________

  • 8/9/2019 Fraudulent Conveyance Quiet Title Packet

    15/22

    Page 4 of 11

    2. I reside at (state your full address) ______________________________________________

    ______________________________________________________________________________

    ______________________________________________________________________________

    3. I have listed my sources and amounts of income truly and correctly on the

    attached affidavit.

    4. I have the following average monthly expenses for the indicated items:

    Housing: __________________ Insurance: ____________________

    Utilities: __________________ Transportation: __________________

    (Gas): __________________ Medical: ____________________

    (Oil): __________________ Loans: ____________________

    (Electric):__________________ Laundry: ____________________

    (Phone): __________________ Child Care: ____________________

    Food: __________________ Child Support: ____________________

    Clothing: __________________

    5. I neither own nor have equity in any assets other than the following (state values in

    dollars): ____________________________________________________________________

    ___________________________________________________________________________

    6. I am unable to pay the costs of these proceedings or to obtain the amount of costs

    from family or friends.

  • 8/9/2019 Fraudulent Conveyance Quiet Title Packet

    16/22

    Page 5 of 11

    Court Term__________________20____and No. ________

    WHEREFORE, Petitioner prays that he/she be permitted to proceed in this matter in

    forma pauperis and without the payment of bond.

    _______________________________________Petitioner (Print your name)

    _______________________________________Petitioner (Sign your name)

  • 8/9/2019 Fraudulent Conveyance Quiet Title Packet

    17/22

    Page 6 of 11

    First Judicial District of PennsylvaniaCourt of Common Pleas of Philadelphia County

    Civil Trial Division

    ____________________________________, pro se(your name)

    ____________________________________

    ____________________________________(full address)

    ____________________________________(area code and telephone number)

    _____________________________________ : ________________________ TERM, 20____: (Month) (Year)

    _____________________________________ :Plaintiff(s) :

    ::

    VS. ::

    _____________________________________ ::

    _____________________________________ :Defendant(s) : NO. _______________________________

    Petitioners AffidavitPursuant to PA. R.C.P. 240

    COMMONWEALTH OF PENNSYLVANIA :

    : SS.

    COUNTY OF PHILADELPHIA :

    1. I, _________________________________________, am the (Plaintiff) (Defendant)(circle one)

    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.

  • 8/9/2019 Fraudulent Conveyance Quiet Title Packet

    18/22

    Page 7 of 11

    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: _____________________________________________________________________

    Address: __________________________________________________________________

    __________________________________________________________________

    Social Security #_____________________________________________________________

    (b) EMPLOYMENT

    If you are presently employed, state:

    Employer : _______________________________________________________________

    Address: _______________________________________________________________

    _______________________________________________________________

    Salary/wagesPer Month: ______________________________________________________________

    Type of Work: ______________________________________________________________

    If you are presently unemployed, state:

    Date of last Employment: __________________________________________________

    Salary/WagesPer Month: ______________________________________________________________

    Type of Work:______________________________________________________________

    (c) OTHER INCOME WITHIN THE PAST TWELVE (12) MONTHS(state as dollar amounts)

    Business or Profession:_______________________________________________________

    Other Self-employment: _____________________________________________________

  • 8/9/2019 Fraudulent Conveyance Quiet Title Packet

    19/22

    Page 8 of 11

    Interest:___________________________________________________________________

    Dividends:_________________________________________________________________

    Pension and Annuities:________________________________________________________

    Social Security Benefits:_______________________________________________________

    Support Payments:___________________________________________________________

    Disability Payments:_________________________________________________________

    Unemployment Compensation &Supplemental Benefits: _____________________________________________________

    Workmans Compensation: ____________________________________________________

    Public Assistance:____________________________________________________________

    Other:_____________________________________________________________________

    (d) OTHER CONTRIBUTIONS TO HOUSEHOLD SUPPORT (state as dollar amounts)

    (Wife) (Husband) (Friend) Name:_______________________________________________

    If your (wife) (husband) (friend) is employed, state:

    Employer: _________________________________________________________________

    Salary/WagesPer Month: ______________________________________________________________

    Type of Work:______________________________________________________________

    ContributionsFrom Children: _____________________________________________________________

    ContributionsFrom Parents: ______________________________________________________________

    Other Contributions:__________________________________________________________

    (e) PROPERTY OWNED (state as dollar amounts)

    Cash:______________________________________________________________________

  • 8/9/2019 Fraudulent Conveyance Quiet Title Packet

    20/22

    Page 9 of 11

    Checking Account:___________________________________________________________

    Savings Account:____________________________________________________________

    Certificates of Deposit:________________________________________________________

    Real Estate

    (Including Home): ___________________________________________________________

    Motor Vehicle: Make _______________________________ Year __________________

    Cost $_________________________________ Amount Owed Z

    Stocks & Bonds: ____________________________________________________________

    Other: _____________________________________________________________________

    _____________________________________________________________________

    (f) DEBTS AND OBLIGATIONS (state as dollar amounts)

    Mortgage: __________________________________________________________________

    Rent: __________________________________________________________________

    Loans: __________________________________________________________________

    Other: __________________________________________________________________

    (g) PERSONS DEPENDENT UPON YOU FOR SUPPORT

    (Wife) (Husband) Name: ______________________________________________________

    Children, if any: _________________________________Age _______________________

    _________________________________Age _______________________

    _________________________________Age _______________________

    _________________________________Age _______________________

    Other Persons:

    Name:_________________________________________________________________

  • 8/9/2019 Fraudulent Conveyance Quiet Title Packet

    21/22

    Page 10 of 11

    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.

    Dated: ____________________ __________________________________________Petitioner (Print your name)

    __________________________________________

    Petitioner (Sign your name)

    Sworn to and subscribed before me this

    ______ day of ______________,20______.

    __________________________________

    Notary Public

  • 8/9/2019 Fraudulent Conveyance Quiet Title Packet

    22/22

    Page 11 of 11

    Certificate of Service

    I hereby certify that I have served a copy of this petition upon all other parties or theirattorney of record by:

    Please check:

    Regular First Class Mail

    Certified Mail

    Other

    Name of Petitioner (Print Name)

    Signature of Petitioner (Sign your name)

    Dated: ________________________