Fill and Sign the Affidavit of Consent of Plaintiff Form

Affidavit of Consent of Plaintiff Form 5 a You, the Plaintiff, may sign an Affidavit of Consent after waiting 90 days from the date the complaint was served. Divorce Form 5 a Affidavit of Consent of Plaintiff Instructions Form 5a – Affidavit of Consent Plaintiff The numbers on these instructions correspond with the numbers in the boxes on the form. Use the form with the boxes to guide you through filling out the blank form. Box 1: Print the name of the county you are filing in exactly as you wrote it on Form 1 . Box 2: Print the name of the Plaintiff exactly at it appears on Form 1 . Box 3: Print the docket number of your case, the same way it was written by the Prothonotary's Office at the time of filing. Box 4 : Print the name of the Defendant exactly as it appears on Form 1. Box 5: Print the date the complaint (Form 1 ) was filed in the Office of the Prothonotary . Box 6: You, the Plaintiff , must write the date you are signing. Box 7: You, the Plaintiff , must sign this form for the entry of the divorce decree. This form must be filed with the Prothonotary / Clerk within thirty (30) days of the day it is signed. 1 IN THE CO URT O F COMMO N PLEAS OF COUNTY, PE NNS YLVA NIA 2 3 , : PLAI NTIFF : 4 : C ase No. v s. : : , : D EFE NDANT AFFI DAVIT OF C ONSENT OF PLAIN TIFF § 3301(c) 5 1. A com plaint in divorce un der § 33 01(c) of t he Div orce Code w as filed on (D ate). 2. The mar riage of Pla intiff and Defendant is ir retrie vably broken and ninety da ys have elapsed fr om the d ate of filing and ser vice of the Com plaint. 3. I consent to the entry of a final decree of di vorce after ser vice of notice of intention to request entry of the decre e. I v erify that the state ments in this docu ment are true and correct. I understand that false state ments herein are m ade su bject to the penalties of 18 Pa. C.S. § 4904, rela ting to uns worn falsif icat ion to author ities. 6 7 D ate: Plaintiff’s Signature Divorce Form 5a Affidavit of Consent of Plaintiff Instructions Divorce Form 5a Affidavit of Consent of Plaintiff Rule 1920.72(b)AOPC 4.18.16 IN TH E C OURT O F COMMON PLEAS OF___ ___________ ______ COUNTY, PENNSYLVANIA _______________________________, : PLAINTIFF : : Case No. ______________ vs. : : IN DIVORCE _______________________________, : DEFENDANT : AFFIDAVIT OF CONSENT OF PLAINTIFF § 3301(c) 1. A c omplaint in divorce under § 3301(c) of the Divorce Code was filed on ________________________________(Date). 2. The marriage of Plaintiff and Defendant is irretrievably broken and ninety day s hav e elapsed 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 notice of intention to request entry of the decree. I verify that the statements in this document 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:_________ _________ __________________________________ Pl aintiff’s Signature