Last updated: 11/11/2013
Statement Of Claim
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Description
PHILADELPHIA MUNICIPAL COURT FIRST JUDICIAL DISTRICT OF PENNSYLVANIA Code: STATEMENT OF CLAIM # Plaintiff Service Address (information) if other than above: Defendant(s) To the Defendant: Plaintiff is seeking a money judgment against the Defendant(s) based on the following claim: Summons to the Defendant You are hereby ordered to appear at a hearing scheduled as follows: Amount Claimed Principal Interest Attorney Fees Other Fees Subtotal Service State Fee Automation Fee Court Costs TOTAL CLAIMED $ $ $ $___________________________ $___________________________ $ $ $ $___________________________ $___________________________ Citation al Demandado Por la presenta, Usted esta dirljido a presentarse a la siguiente: Date Filed: _____________ I, the undersigned, verify and depose that the facts set forth in this Complaint are true and correct and acknowledge that I am subject to the penalties of 18 P.S. 4904 relating to Unsworn Falsification Authorit ies. ____________________________________________ Signature Plaintiff/Attorney Atty ID #:________________ Address & Phone NOTICE TO THE DEFENDANT, YOU HAVE BEEN SUED IN COURT. PLEASE SEE ATTACHED NOTICES. AVISO AL DEMANDADO LE HAN DEMANDADO EN C O RTE. VEA POR FAVOR LOS AVISOS ASOCIADOS. If you wish to resolve this matter without appearing in court, please contact the attorney shown above immediately. American LegalNet, Inc. www.FormsWorkFlow.com
