(Caption)
COMPLAINT FOR INDIRECT CRIMINAL CONTEMPT FOR VIOLATION OF PROTECTION FROM ABUSE ORDER
I, the undersigned, do hereby state:
I verify that the statements made in the complaint are true and correct to the best of my knowledge, information and belief. I further understand that any false statements made herein are subject to the penalties of 18 Pa.C.S. § 4904 relating to unsworn falsification to authorities.
Date _________________ _________________ (Signature of Affiant)
The above subscribed affiant personally appeared before me on ______, ______, signed the complaint in my presence and asserted that the facts therein are true and correct; and wherefore it appears that there is probable cause for the issuance of process.
(SEAL) (Issuing Authority)
Beav. Cnty. Pa. 1901.5