I hereby certify that I am this day serving the foregoing document upon the persons and in the manner indicated below, which service satisfies the requirements of Pa.
R.A.P. 121:
Service by first class mail addressed as follows:
Name Telephone number
Mailing address
(Party represented)
Acceptance of service endorsed by the following:
Name, Telephone number
Mailing address
(Party represented)
Service in person as follows:
Name, Telephone number
Street Address
Mailing address (if different)
(Party represented)
Service by commercial carrier as follows:
Name of commercial carrier
Addressee's name, Telephone number
Street address
Mailing Address (if different)
(Party represented)
Service by e-mail at following:
E-mail address, with agreement of:
Name, Telephone number
Mailing address
(Party represented)
Service by facsimile at following:
Fax number with the agreement of:
Name, Telephone number
Mailing address
(Party represented)
Date:
(S) ____________________
Name, Telephone number
(Attorney Registration No. 00000)
Mailing address
(Party represented)
210 Pa. Code r. 122