IN THE COURT OF COMMON PLEAS OF BUCKS COUNTY, PENNSYLVANIA CIVIL DIVISION File No.__________________________ WRIT OF CERTIORARI TO DISTRICT JUSTICE PRAECIPE FOR WRIT OF CERTIORARI Magisterial District No. _________________________ District Justice Docket No. ___________________________ Name of Party Filing This Praecipe and Obtaining This Writ ____________________________________________________ ____________________________________________________________________________________________________ Date of Entry of Judgment ______________________________________________________________________________ In the Case of ________________________________________________________________________________________ (Plaintiff) vs. (Defendant) The party named above claims that with respect to the above proceeding there was: (Check applicable box or boxes) (___) lack of jurisdiction over the subject matter (___) lack of jurisdiction over (name of party)____________________________________________________ (___) such gross irregularity as to make the judgment void PRAECIPE: To the Prothonotary Issue a Writ of Certiorari directing ____________________________________, District Justice, to transmit to you a certified true copy of the record of the proceedings named above. ________________________________________________ Signature of Party Filing Praecipe or Attorney Print Name:_______________________________________ WRIT OF CERTIORARI TO:________________________________________, District Justice (1) You are hereby directed by this writ to transmit to the Prothonotary of this Court of Common Pleas, within ten days after you receive this writ, a certified true copy of the record of the proceedings named above. (__) (2) This writ, when received by you, will operate as a SUPERSEDEAS to the judgment for possession in this case. This block will be checked ONLY when this notation is required pursuant to PA. R.C.P.D.J. No. 1013B. Date delivered for service________________, 20______ _______________________________________________ Prothonotary by:_______________________________________________ Deputy (05/04) American LegalNet, Inc. www.USCourtForms.com PROOF OF SERVICE OF WRIT OF CERTIORARI (This proof of service must be filed within five days after delivery of the writ for service. Check applicable boxes) COMMONWEALTH OF PENNSYLVANIA COUNTY OF BUCKS: ss AFFIDAVIT: I hereby verify that I served the writ of Certiorari, Common Pleas Docket No._________________, upon the District Justice to whom it was directed on (date of service) ______________________, 20_________ (___) by personal service (___) by (certified) (registered) mail, sender's receipt attached hereto, and that I served a copy of the writ upon the opposite party(ies) (name(s)) _____________________________ ________________________________________________________________________________________ on (date of service) ___________________, 20__________, (__) by personal service (__) by (certified0 (registered) mail, sender's receipt attached hereto. 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. Date:____________________, 20_______. _____________________________________________ Signature of Affiant American LegalNet, Inc. www.USCourtForms.com