STATE OF MAINE DISTRICT COURT Location Docket No. IMPORTANT NOTICE TO PLAINTIFF You are hereby notified that it is a crime to make a false statement under oath in a court document. See 19 - A M.R.S.A. 244 4005(5). See also 17 - A M.R.S.A. chapter 19. Date: Plaintiff Personally appeared the above - named Plaintiff and acknowledged receipt of this Notice that will remain in the court file. Date: Clerk/Notary Public PA - 017, Rev. 08/09 American LegalNet, Inc. www.FormsWorkFlow.com