Prothonotary Refund Application
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Prothonotary Refund Application Form. This is a Pennsylvania form and can be use in Philadelphia Local County.
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Tags: Prothonotary Refund Application, 10-285, Pennsylvania Local County, Philadelphia
FIRST JUDICIAL DISTRICT OF PENNSYLVANIA
COURT OF COMMON PLEAS OF PHILADELPHIA
OFFICE OF THE PROTHONOTARY
PROTHONOTARY REFUND APPLICATION
Return to:
ROOM 282 CITY HALL
PHILADELPHIA PA 19107
or Fax to 215-686-3793
NAME AND ADDRESS OF PAYEE:
APPROVED BY:
________________________________
_______________________________
Prothonotary, Finance Dept.
________________________________
________________________________
Amount of Refund Request:
________________________________
$______________________________
CASE CAPTION:
Court Term & Number:
________________________________
_______________________________
VS.
________________________________
STATEMENT OF FACTS:
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
Note: Please attach your original cash register receipt or proof of payment, along with a copy of
the civil docket report.
PAYEE’S SIGNATURE:
________________________________
Date: __________________________
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