THE COURT OF COMMON PLEAS OF BUCKS COUNTY, PENNSYLVANIA CIVIL DIVISION JUDGMENT NOTE TO RECORD A JUDGMENT NOTE IN BUCKS COUNTY, PLEASE SEND: Check in the amount of $21.75 payable to the Prothonotary Original note with original signature (Note must have the Judgment clause) Certification of address for both Plaintiff and Defendant Affidavit of Non-Military service (if defendant is an individual) Affidavit of non-consumer credit transaction A complete copy of the above filings for each plaintiff and defendant A 236 Notice for each defendant (Pa. RCP 236) Envelopes, addressed and stamped for each defendant and for your office American LegalNet, Inc. www.FormsWorkFlow.com THE COURT OF COMMON PLEAS OF BUCKS COUNTY, PENNSYLVANIA CIVIL DIVISION AFFIDAVIT OF VALUE 26.4 AFFIDAVIT � VALUE (Court Caption) (Parties) No:____________ AFFIDAVIT OF VALUE COMMONWEALTH OF PENNSYLVANIA) ss: COUNTY OF __________________________) __________________________, being duly sworn according to law, deposes and says that he is an officer of plaintiff; that he is authorized to make this affidavit on behalf of plaintiff; and that defendant entered into the Note dated _____________ in the sum of $_________________, a true and correct copy of which is attached to the Complaint as Exhibit "A". Deponent also avers that there is $___________ due and owing under the Note, plus late charges of $_______________ to the date hereof and attorney fees of $_____________. ________________________ (Name) (Title) SWORN to and subscribed before me this ______ day of __________________, 20___ ________________________ Notary Public American LegalNet, Inc. www.FormsWorkFlow.com THE COURT OF COMMON PLEAS OF BUCKS COUNTY, PENNSYLVANIA CIVIL DIVISION VERIFICATION OF NON-APPLICABILITY OF GOODS AND SERVICES INSTALLMENT SALES ACT and AFFIDAVIT of NON-CONSUMER TRANSACTION I, __________________________, being duly sworn according to law, depose and state that I am a _________________________________, that I have sufficient knowledge of the facts to make this Verification and that this Confession of Judgment does not arise out of a "retail instrument sale, contract or account" as defined under the Goods and Services Installment Sales Act, 69 P.S. Section 1101 et sec, nor is judgment being entered against natural persons in connection with a "consumer credit transaction" as that term is defined in Pennsylvania Rule of Civil Procedure 2950 (as amended July 1, 1996). I further state that this verification is taken subject to the penalties of 18 Pa. C.S.A. 4904 relating to unsworn falsification to authorities. BY:_________________________________ (Revised: 2/4/13) American LegalNet, Inc. www.FormsWorkFlow.com