231 Pa. Code r. 1910.13-2
[CAPTION]
REQUEST FOR BENCH WARRANT AND
SUPPORTING AFFIDAVIT
_________________________ County on the ___ day of ____________ ,. ___ , which was scheduled by an order of court compelling this person's appearance, a copy of which is attached to this request.
[] (a) The order of court (i) was served upon the party by ordinary mail with the return address of the court thereon; (ii) the mail was not returned to the court within fifteen (15) days after mailing; and (iii) at a date after the order of court was mailed, the United States Postal Service has verified that mail for the party was being delivered at the address to which the court order was mailed.
[] (b) The party signed a receipt indicating acceptance of the court order.
[] (c) An employee of the court handed a copy of the court order to the party. The employee's affidavit of service is attached.
[] (d) A competent adult handed a copy of the court order to the party. The adult's affidavit of service is attached.
[] I have reviewed the records of the Court and the Domestic Relations Office concerning this case, and attest that the party has not appeared for any domestic relations matter involving the same parties since the date upon which the party failed to appear in violation of the attached order of court.
The records of the Domestic Relations Section show that:
[] the party owes support arrearages in the amount of $ ___.
the party has failed to appear for ___ hearings relating to this case.
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. § 4904 relating to unsworn falsification to authorities.
DATE: ____________
__________________________________________
NAME/OFFICIAL TITLE
[CAPTION]
BENCH WARRANT
AND NOW, this ___ day of ____________ ,20 ___ , the Sheriff of____________ County, or any constable, or police officer, or other law enforcement officer is hereby ordered to take ____________ , residing. ____________ , into custody for appearance before this Court.
This bench warrant is issued because it appears that the (plaintiff) (defendant) has failed to appear, after notice, before the court for a scheduled conference and/or hearing.
We command you, the arresting officer, forthwith to convey and deliver the party into the custody of the Court of Common Pleas of ____________
County at
____________ , ____________ ,
(address)(city)
Pennsylvania, for a hearing.
DESCRIPTIVE INFORMATION
Social Security # ____________ Sex ___
D. O.B. ____________ Age ___ Height ___
Weight ___ Race ____________ Eyes ___
Hair ___
Distinguishing features (scars, tattoos, facial hair, disability, etc.) ______________________________________
______________________________________
Alias ______________________________________
Telephone # ____________
You are further commanded that if the court is unavailable, the party may be held in the County Jail until the court is opened for business, at which time the party shall be promptly conveyed and delivered into the custody of the court.
_________________________ , ____________ ,
(address) (city)
Pennsylvania, for hearing.
The authority in charge of the county jail shall notify the sheriff's office and the director of the domestic relations section forthwith that the party is being held pursuant to the bench warrant.
Under no circumstances may the party be held in the county jail of the county that issued this bench warrant for more than 72 hours or the close of the next business day if the 72 hours expires on a non-business day. See Pa.R.Crim.P 150(A)(5).
Bail in this matter shall be set as follows:
[] No bail.
[] Bail to be set in the amount of ___.
BY THE COURT: ______________________________________
JUDGE
231 Pa. Code r. 1910.13-2