IN THE COURT OF COMMON PLEAS OF LEHIGH COUNTY, PENNSYLVANIA CIVIL DIVISION : : Plaintiff : vs. : File No. : IN DIVORCE : Defendant : Counter-Affidavit Under 247 3301(d) of the Divorce Code 1. 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 a period 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. (ii) The marriage is not irretrievably broken. (iii) There are economic claims pending. American LegalNet, Inc. www.FormsWorkFlow.com (Rev.12/17 form 12) 2. Check either (a), (b) or (c): (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 or expenses if I do not claim them before a divorce is granted. (b) I wish to claim economic relief which may include alimony, division of property, lawyer's fees or expenses or other important rights. I UNDERSTAND THAT IN ADDITION TO CHECKING (b) ABOVE, I MUST ALSO FILE ALL OF MY ECONOMIC CLAIMS WITH THE PHOTHONTARY IN WRITING AND SERVE THEM ON THE OTHER PARTY. IF I FAIL TO DO SO BEFORE THE DATE SET FORTH ON THE NOTICE OF INTENTION TO REQUEST DIVORCE DECREE, THE DIVORCE DECREE MAY BE ENTERED WITHOUT FURTHER NOTICE TO ME, AND I SHALL BE UNABLE THEREAFTER TO FILE ANY ECONOMIC 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. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S. 247 4904, relating to unsworn falsification to authorities. Date: DEFENDANT NOTICE: IF YOU DO NOT WISH TO OPPOSE THE ENTRY OF A DIVORCE DECREE AND YOU DO NOT WISH TO MAKE ANY CLAIM FOR ECONOMIC RELIEF, YOU SHOULD NOT FILE THIS COUNTER-AFFIDAVIT. American LegalNet, Inc. www.FormsWorkFlow.com