IN THE COURT OF COMMON PLEAS OF LUZERNE COUNTY, PENNSYLVANIA CIVIL DIVISION : : : : : : : : : vs. Docket Number: PRAECIPE AND POWER OF ATTORNEY FOR SATISFACTION AND/OR TERMINATION TO THE PROTHONOTARY/CLERK 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 suit is Settled, Discontinued, Ended WITH Prejudice and costs paid. 3. _____ The within suit 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 registered attorney): ___________________________________________________ Signature of authorizing party _______________________________ 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 PENALTIES OF 18 Pa. C.S.A. § 4904 RELATING TO UNSWORN FALSIFICATION TO AUTHORITIES. _____________________________________________ Signature B-1F-1 (Rev. 4/00) American LegalNet, Inc. www.FormsWorkflow.com