Step By Step Instructions For Filling Out Form 12 Page 3

Attorney for Plaintiff

__________________

COURT OF COMMON PLEAS

Plaintiff,

PHILADELPHIA COUNTY

FAMILY DIVISION

vs.

TERM, 20

Defendant.

NO.

WAIVER OF NOTICE OF INTENTION

TO REQUEST ENTRY OF A DIVORCE DECREE

UNDER SECTION 3301(c) OF THE DIVORCE CODE

1. I consent to the entry of a final decree in 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. Section 4904 relating to

unsworn falsification to authorities.

Date: _____________________

_________________________

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