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County

PLAINTIFF Case No. IN DIVORCE

Plaintiff

Case No

VS. DEFENDANT

Defendant

COUNTER-AFFIDAVIT UNDER SECTION 3301(d) OF THE DIVORCE CODE

1. Check either (a) or (b):

Check if you do not oppose the entry of a divorce decree

(a) I do not oppose the entry of a divorce decree.

Check if you oppose the entry of a divorce decree because (see below)

(b) I oppose the entry of a divorce decree because:

Check (i), (ii), (iii) or all:

Check if the parties to this action have not lived separate and apart for the required separation period

(i) The parties to this action have not lived separate and apart for the required separation period: two years for parties that separated prior to December 5, 2016, and one year for parties that separated on or after December 5, 2016.

Check if the marriage is not irretrievably broken

(ii) The marriage is not irretrievably broken.

Check if there are economic claims pending

There are economic claims pending.
Check (a), (b) or (c):

Check if you do not wish to make any claims for economic relief.

(a) I do not wish to make any claims for economic relief. 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 them before a divorce is granted.

Check if you wish to claim economic relief

(b) I wish to claim economic relief, which may include alimony, division of property, lawyer's fees, costs and expenses, or other important rights.

I UNDERSTAND THAT IN ADDITION TO CHECKING (2)(b), I MUST ALSO FILE ALL OF MY ECONOMIC CLAIMS IN WRITING AND SERVE THEM ON THE OTHER

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PARTY. IF I FAIL TO DO SO BEFORE THE DATE SET FORTH ON THE NOTICE OF INTENTION TO FILE THE PRAECIPE TO TRANSMIT RECORD, THE DIVORCE DECREE OR ORDER APPROVING GROUNDS FOR DIVORCE MAY BE ENTERED WITHOUT FURTHER NOTICE TO ME, AND I MAY BE UNABLE THEREAFTER TO FILE ANY ECONOMIC CLAIMS.

Check if economic claims have been raised and are not resolved

I verify that the statements made in this counter-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: _____

Date - enter as mm/dd/yyyy ex. 09/27/2015

(PLAINTIFF) (DEFENDANT)

NOTICE: IF YOU DO NOT WISH TO OPPOSE THE ENTRY OF A DIVORCE DECREE OR ORDER APPROVING GROUNDS FOR DIVORCE AND YOU DO NOT WISH TO MAKE ANY CLAIM FOR ECONOMIC RELIEF, YOU SHOULD NOT FILE THIS COUNTER-AFFIDAVIT.

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IN THE COURT OF COMMON PLEAS FOR ADAMS COUNTY, PENNSYLVANIA CIVIL ACTION - LAW

Name1(CICForm)

Name	PLAINTIFF
vs.
Name	DEFENDANT 1
and (if applicable)
Name	DEFENDANT 2

Name2(CICForm)

Name3(CICForm)

Case(CICForm)

CASE NO. _____

CERTIFICATE OF COMPLIANCE

I certify that this filing complies with the provisions of the Case Record 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.

Signature: _____

Petitioner Date: _____

Print Name: _____

Name4(CICForm)

Date:

Date(CICForm)