IN THE COURT OF COMMON PLEAS
___________________________
PLAINTIFF
DAUPHIN COUNTY, PENNSYLVANIA
vs.
NO. _____________________________
_____________________________
DEFENDANT
SELF-REPRESENTED PARTY ENTRY OF APPEARANCE
_______________________________________________________. I understand that this address will be the only address to which notices and pleadings in this case will be sent, and that I am responsible to regularly check my mail at this address to ensure that I know of important deadlines or scheduled proceedings.
is ______________________________________. My Email is ___________________________________.
Name______________________________ Address__________________________________________________
Name______________________________ Address__________________________________________________
Name______________________________ Address__________________________________________________
Name______________________________ Address__________________________________________________
I verify that the statements made in this Entry of Appearance as a Self-Represented Party are true and correct. I understand that if I make false statements herein, that I am subject to the criminal penalties of 18 Pa.C.S. § 4904 relating to unsworn falsification to authorities which could result in a fine and/or prison term.
_________
Date
__________________
Signature (Your Signature)
Daup. Cnty. Pa. 1012