Chest. Cnty. Ct. Comm. Plea. R., form 3
See CCRCP 1905.A.(b): form req'd by CCRCP 1901.5.A.(a)
PROTECTION FROM ABUSE
INDIRECT CRIMINAL CONTEMPT AFFIDAVIT
On _______________________, 20___, _____________________________________
(Name of Defendant)
did commit the following in violation of a protection from abuse order entered by a Judge of the Court of Common Pleas of Chester County, Pennsylvania on ____________________, 20_____ Docket No. ______________________.
The acts committed were:
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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.
_____________________ Witness | _____________________ Affiant |
Date: ____________________ | Name:_________________________ Address:_______________________ _____________________ _____________________ |
Chest. Cnty. Ct. Comm. Plea. R., form 3