Fill and Sign the Notice is Given that the Appellant Has Filed in the above Court of Common Pleas an Appeal from the Judgment Rendered by the Form

COMMONWEALTH OF PENNSYLVANIA COURT OF COMMON PLEAS Judicial District, County Of NOTIC E OF APPEAL FROM MAGISTERIA L DISTRIC T JUDG E JUDGMENT COMMON PLEA S No. NOTIC E OF APPEAL Notice is given that the appellant has filed in the above Court of Common Pleas an appeal from the judgment rendered by the Magisterial District Judge on the dat e and in the cas e referenced below. NAM E OF APPELLANT MAG . DIST . NO. NAM E OF MDJ ADDRES S OF APPELLAN T CITY STATE ZIP CODE DATE OF JUDGMENT IN THE CAS E OF ( Plaintiff ) (Defe ndan t)` vs DOCKE T No. SIGNATUR E OF APPELLAN T OR ATTORNE Y OR AGENT This block will be signed ONLY when this notation is required under Pa. R.C.P.M.D.J. No. 1008. Thi s Notic e of Appeal , when receive d by the Magisteria l Distric t Judg e , will operate a s a SUPERSEDEA S to th e judgmen t for possessio n in thi s case. Signature of Prothonotar y or Deputy If appellan t wa s Claiman t (see Pa. R.C. P.M. D.J. No . 1001(6 ) in action before a Magisterial District Judge, A COMPLAINT MUST BE FILED within twenty (20) days after filing the NOTICE of APPEAL. PRAECIPE TO ENTER RULE TO FILE COMPLAINT AND RULE TO FILE (This section of form to be used ONLY when appellant was DEFENDANT (see Pa.R.C.P.M.D.J. No. 1001(7) in action before Magisterial D istrict Judge. IF NOT USED, detach from copy of notice of appeal to be served upon appellee. PRAECIPE: To Prothonotary Enter rule upon appellee(s), to file a complaint in this appeal Name of appellee(s) (Commo n Pleas No. ) withi n twent y (20) days afte r servic e of rule or suffer entr y of judgment of non pros. __________________________________________________ Signature of appellant or attorney or agent RULE : To , appellee(s) Name of appell ee(s) (1)You ar e notifie d tha t a rule is hereby entered upon yo u to file a complain t in this appeal within twent y (20 ) day s afte r th e dat e of service of this rule upon you by personal service or by certified or registered mail. (2)If you do not file a complaint within this time, a JUDGMENT OF NON PROS MAY BE ENTERED AGAINST YOU. (3)The dat e of servic e of this rule if service was by mail is the dat e of the mailing. Date: , 20 __________________________________________ Signature of Prothonot ary or Deputy YOU MUS T INCLUD E A COPY OF THE NOTIC E OF JUDGMENT/TRANSCRIP T FOR M WIT H THI S NOTIC E OF APPEAL. The appellee and the magisterial district judge in whose office the judgment was rendered must be served with a copy of this Notice pursuant to Pa.R.C.P.M.D.J. 1005(A). AOPC 312-05 PROOF OF SERVICE OF NOTICE OF APPEAL AND RULE TO FILE COMPLAINT (This proof of service must be filed within 10 days after filing of the notice of appeal) I hereby certify that I served the Notice of Appeal, Common Pleas No. _______________ ____________, upon the Magisterial District Judge designated therein on ___________________, ________ by personal s e r v i c e, or certified or registered mail, sender's receipt attac hed hereto, ________________________________ Signature AOPC 312 A - 05 and upon the appellee, ___________________, on ______________, ______ by personal service, or certified or registered mail, sender's receipt attached hereto, I verify that the statements herein are true and correct. I understand that false statements herein are made subject to the penalties of Section 4904 of the Crimes Code (18 Pa.C.S. § 4904) relating to unsworn falsification to authorities. . By: ______________________________ Name Date: ___________________________