COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ........ .. COMMONWEALTH OF.PENNSYLVANIA : Index No. WRIT OF CERTIORARI COURT OF COMMON PLEAS TO Calendar No. : JUDICIAL DISTRICT Plaintiff(s) : DISTRICT JUSTICE JUDICIAL SUBPOENA COMMON PLEAS No. -against: PRAECIPE FOR WRIT OF CERTIORARI NAME OF PARTY FILING THIS PRAECIPE AND OBTAINING THIS WRIT CLAIM NO. CV 20 LT 20 (DEFENDANT) : DATE JUDGMENT RENDERED IN THE CASE OF (Plaintiff) Vs. : The party named above claims that with respect to the above proceedings there was: (Check applicable box or boxes) Defendant(s) : . . . . . . . . . . subject matter .. .. lack of .jurisdiction.over. the . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .lack .of jurisdiction over (Name of party) improper venue such gross irregularity of procedure as to make the judgment void PRAECIPE: To the Prothonotary THE PEOPLE OF THE STATE OF NEW YORK Issue Writ of Certiorari directing to transmit to you a certified copy of the record of the proceedings named above. TO District Justice (Signature of party filing Praecipe or his attorney or agent) GREETINGS: WRIT OF CERTIORARI WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before District , the Honorable at the Justice Court located at to the Prothonotary of this Court of Common Pleas, within ten (10) days County of 1. You are hereby directed by this writ to transmit in room , on the day of 20 , at o'clock in the noon, and at any recessed after you receive this writ, a certified true copy of the record of ,the proceedings named above. or adjourned date, to testify and give evidence as a witness in this action on the part of the To: , 2. This writ, when received by you, will operate as a SUPERSEDEAS to the judgment for possession in this case. This block will be checked ONLY when this notation is required under Pa. R.C.P.D.J. No. 1013B. Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a Date delivered for service result of your failure to comply. , 20, (Signature of Prothonotary or Deputy) COURT FILE Witness, Honorable , one of the Justices of the PROOF OF SERVICE OF WRIT OF CERTIORARI Court in County, day of , 20 (This proof of service MUST BE FILED WITHIN TEN (10) DAYS AFTER delivery of the writ for service) COMMONWEALTH OF PENNSYLVANIA COUNTY OF ; ss (Check applicable boxes) (Attorney must sign above and type name below) AFFIDAVIT: I hereby swear or affirm that I served the Writ of Certiorari, Common Pleas No. , upon the District Justice to whom it was by personal service, by (certified) (registered) mail, sender’s receipt attached hereto, and that I served a directed on , 20 , copy of the writ upon the opposite party(ies) (name or names): on by personal service by (certified) (registered) mail, sender’s receipt attached hereto. , 20 , SWORN (AFFIRMED) AND SUBSCRIBED BEFORE ME THIS DAY OF , 20 Attorney(s) for . (Signature of affiant) (Signature of official before whom affidavit was made) Office and P.O. Address (Title of official) My Commission expires on (6/02) , 20 Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: TO BE FILED IN TRIPLICATE American LegalNet, Inc. www.USCourtForms.com