IN THE COURT OF COMMON PLEAS, DAUPHIN COUNTY, PENNSYLVANIA CIVIL DIVISION : : : : Vs. : File No. : : : : PRAECIPE AND POWER OF ATTORNEY FOR SATISFACTION AND/OR TERMINATION TO THE PROTHONOTARY OF SAID COURT: You are hereby authorized, empowered, and directed to enter, as indicated, the following on the records thereof: A. 1. The within suit is Settled, Discontinued, Ended and costs paid. 2. The within is Settled, Discontinued, Ended WI Prejudice and costs paid. TH 3. The within is Settled, Discontinued, Ended WITHOUT Prejudice and costs paid. ******* B. 1. Satisfaction of the Award in the within suit is acknowledged. 2. Satisfaction of Judgment, with interest and costs, in the within matter is acknowledged. ******* C. Other: DATE: WITNESS (if signer is other than a Signature of authorizing party registered attorney): Attorney or Notary Type or print name of above signer COST PAYMENT VERIFICATION I UNDERSTAND THAT THE ABOVE ACTION CANNOT BE FILED AND DOCKETED UNTIL ALL COSTS HAVE BEEN PAID, INCLUDING SHERIFF S COSTS; AND HEREBY VERIFY THAT ALL COSTS HAVE BEEN PAID. I UNDERSTAND THAT FALSE STATEMENTS HEREIN ARE MADE SUBJECT TO THE PENALITIES OF 18 Pa .C.S. SEC. 4904 RELATING TO UNSWORN FALSIFICATION TO AUTHORITIES. Signature PROTHON. 59 (8-97) American LegalNet, Inc. www.USCourtForms.com