Instructions for:
Form 5-B
Affidavit of Consent (Defendant)
Form 5-B Affidavit of Consent (Defendant)
The numbers on these instructions correspond with the numbers in the arrowboxes on the
form. Use the form with the arrowboxes to guide you through filling out the blank form.
1. Write the name of the county you are filing in by arrowbox 1. Write exactly what
you wrote on Form 1, by arrowbox 1.
2. Write the name of the Plaintiff by arrowbox 2. Write it exactly as it appears on
Form 1, by arrowbox 2.
3. Write the name of the Defendant by arrowbox 3. Write it exactly as it appears on
Form 1, by arrowbox line 3.
4. Write the docket number by arrowbox 4. The docket number is the number that
the Prothonotary's Office wrote on Form 1, by arrowbox 4 at the time of filing.
5. Write the date Form 1 was filed in the Office of the Prothonotary by arrowbox 5.
6. Your spouse must write the date by arrowbox 6, if your spouse consents to the
entry of the Divorce Decree.
7. Your spouse must sign this form by arrowbox 7, if your spouse consents to the
entry of the Divorce Decree.
8. File this form with the Prothonotary within thirty (30) days.
Form 5-B
Page 1 of 1
IN THE COURT OF COMMON PLEAS OF
_______________________ COUNTY, PENNSYLVANIA
_______________________________, : CIVIL ACTION LAW
PLAINTIFF :
:
: Case No. ______________
vs. :
:
_______________________________, :
DEFENDANT : IN DIVORCE
AFFIDAVIT OF CONSENT
1. A Complaint in Divorce under Section 3301(c) of the Divorce Code was filed on
________________________________(date Complaint filed).
2. The marriage of Plaintiff and Defendant is irretrievably broken and ninety (90) days
have elapsed from the date of filing and service of the Complaint.
3. I consent to the entry of a final decree of divorce, and have signed a Waiver of Notice
of Intention to Request Entry of Decree.
I verify that the statements in this document are true and correct to the best of my
knowledge, information, and belief. 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:____________________ __________________________________
Defendant’s Signature
1
2
3
4
5
6
7
IN THE COURT OF COMMON PLEAS OF
_______________________ COUNTY, PENNSYLVANIA
_______________________________, : CIVIL ACTION LAW
PLAINTIFF :
:
: Case No. ______________
vs. :
:
_______________________________, :
DEFENDANT : IN DIVORCE
AFFIDAVIT OF CONSENT
1. A Complaint in Divorce under Section 3301(c) of the Divorce Code was filed on
________________________________(date Complaint filed).
2. The marriage of Plaintiff and Defendant is irretrievably broken and ninety (90) days have
elapsed from the date of filing and service of the Complaint.
3. I consent to the entry of a final decree of divorce, and have signed a Waiver of Notice of
Intention to Request Entry of Decree.
I verify that the statements in this document are true and correct to the best of my
knowledge, information, and belief. 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:____________________ __________________________________
Defendant’s Signature