231 Pa. Code § 1042.11
(Caption)
Notice of Intention to Enter Judgment of Non Pros
for Failure to File Written Statement from
an Appropriate Licensed Professional
To: ____________
(Identify Party)
Pursuant to Pennsylvania Rule of Civil Procedure 1042.12, I intend to enter a judgment of non pros against you after thirty (30) days of the date of the filing of this notice if a written statement from an appropriate licensed professional is not filed as required by Rule 1042.3(e).
I am serving this notice on behalf of _________________________
(Name of party)
The judgment of non pros will be entered as to the following claims:
______________________________________
______________________________________
(State if a judgment is to be entered as to all claims. Otherwise, identify claims set forth in the complaint as to which a judgment of non pros will be entered.)
____________
(Attorney)
____________
(Address)
____________
(Telephone Number)
231 Pa. Code § 1042.11