IN THE COURT OF COMMON PLEAS OF ____________________________ COUNTY, PENNSYLVANIA CIVIL DIVISION : : : : : : : File No.________________________________ PRAECIPE FOR JUDGMENT Enter Judgment in favor of Plaintiff / Defendant and against: _______________________________________________________________________________________ for want of ________________________________________. (_____) Assess damages as follows: Debt---------------------------------------- $___________________ Interest from ________________ ___________________ Attorney's Commission ------------- ___________________ TOTAL ----------------------------------- $___________________ (_____) I certify that the foregoing assessment of damages is for specified amounts alleged to be due in the complaint and is calculable as a sum certain from the complaint. (____ ) Pursuant to Pa. R.C.P. No. 237 (notice of praecipe for final judgment or decree), I certify that a copy of this praecipe has been mailed to each other party who has appeared in the action or to his or her Attorney of Record. (_____) Pursuant to Pa. R.C.P. No. 237.1, I certify that written notice of the intention to file this praecipe was mailed or delivered to the party against whom judgment is to be entered and to his or her Attorney of Record, if any, after the default occurred and at least ten (10) days prior to the date of the filing of this praecipe and a copy of the notice is attached. Date: ______________________ Signature: _________________________________ Print Name: ________________________________ Attorney for: ________________________________ Address: ___________________________________ ____________________________________ Telephone: _________________________________ Supreme Court ID No.: _______________________ NOW, ________________________, __________, JUDGMENT IS ENTERED AS ABOVE. __________________________________________ Prothonotary/Clerk, Civil Division by: _______________________________________ Deputy M-2F-1 (Rev. 4/00) American LegalNet, Inc. www.FormsWorkflow.com