IN THE COURT OF COMMON PLEAS OF MONTGOMERY COUNTY, PENNSYLVANIA : VS. : : : Assessment of Damages : Yes No (Circle Yes or No) Only NO. ARBITRATION PRAECIPE TO THE PROTHONOTARY: Please have the above case scheduled for arbitration. Listed below are the names of all trial counsel. Counsel agree that all pre-trial motions have been disposed of and discovery is completed. Agreements of counsel to continue discovery after the filing of this praecipe shall not be recognized by the Court as grounds for the continuance of any cases listed for arbitration. Attorney for Plaintiff/ID Number ____________________________________ Attorney for Plaintiff/ID Number Attorney for Defendant/ID Number __________________________________________ Attorney for Defendant/ID Number Unrepresented Plaintiff/Telephone Number Unrepresented Defendant/Telephone Number Companion Case/Consolidated Case No.(s): (include date consolidated) For Attorney Use Only: It is hereby certified by filing counsel that he/she has received the affirmative consent, either in writing or verbally, of all counsel to have this matter scheduled for trial. Signature of Filing Attorney For Unrepresented Parties Only: Date If all parties to an action are unrepresented, any such party can certify the case for trial. Signature of Filing Unrepresented Party Date Revised 2/11 American LegalNet, Inc. www.FormsWorkFlow.com