INFORMATION ON FILING SUMMARY APPEALS (To Appellant: PLEASE READ CAREFULLY) A $44.50 filing fee must accompany each properly-completed Summary Appeal form. The $44.50 is non-refundable; it is paid to the Clerk of Courts and later forwarded to the County Treasurer. If you are appealing more than one case with the same prosecutor, and the matter was heard by the District Justice at the same time, you may file one appeal form. If the prosecutors differ or if the matters were heard at different times, a separate form must be filed for each. The fee for each form is $44.50. If you are without funds to pay the filing fee, you must prepare and submit to the Court a Petition to Proceed in Forma Pauperis. We have forms, or you may go to the Law Library located in the basement of this building to research the preparation of a formal petition. There are no exceptions – you must have the necessary fee or permission from the Court to proceed IFP. THIS FORM MUST BE SUBMITTED TO THE COURT AT MOTIONS COURT IN PERSON. This office will provide notification of the assigned initial hearing date to the Appellee (person filing), the District Justice, the District Attorney, and the Affiant (prosecuting officer). THIS IS THE ONLY NOTICE THAT YOU WILL RECEIVE OF THE HEARING. You must be present in court at the assigned time, prepared to proceed with your case. If you have engaged the services of an attorney, he/she should be present with you in court. The attorney must enter an appearance to receive all notices. If the assigned date for hearing is inconvenient, you or your attorney must petition the Court for a continuance. If the Court grants a continuance, you or your attorney must file the Order with the Clerk who will notify the District Attorney of the continuance. Should the Commonwealth seek a continuance, you and your attorney will be notified of the continuance by regular mail at the address indicated on your appeal form. If your address should change, please notify this office immediately. This properly-completed form may be mailed to the Clerk of Courts, Ste. 1005, Washington County Courthouse, Washington, PA 15301 along with the $44.50 fee. You will receive a hearing notice by return mail. If you appear in person to file your appeal, a hearing date will be given to you at the time of filing. At the time of sentencing, the Court will impose sentence which may include costs and fines. You will be expected to pay in full any amount due on the date of sentencing. If you cannot pay, you must request additional time directly from the Court at your sentencing hearing. The Court will instruct you as to your appeal rights. If payment arrangements are to be made, please report to the Clerk of Courts Collection Department (located in the basement of this building). Within ten (10) days of the disposition of your case, if appropriate, a form will be submitted to the Department of Transportation for updating your file. Barbara Gibbs, Clerk of Courts LICENSE INFORMATION FOR LICENSE IN JEOPARDY OF SUSPENSION/NOT POINTS: If your appeal is from a motor vehicle conviction that will result in the suspension of your driver’s license, you may obtain a certification from the Clerk of Courts that you have filed an appeal. You must mail this form and a certified copy of your Notice of Appeal form to: PA DEPARTMENT OF TRANSPORTATION, Correspondence Unit, P.O. Box 68618, Harrisburg, PA 17106. American LegalNet, Inc. www.FormsWorkflow.com IN THE COURT OF COMMON PLEAS OF WASHINGTON COUNTY, PENNSYLVANIA NOTICE OF APPEAL FROM SUMMARY CONVICTION Name and Address of Defendant Date of Appeal Issuing Authority Dkt. No. Citation No. Magisterial District No. Zip Date of District Justice Sentence for Offense(s) Date of entry of guilty plea, conviction, or other final order from which appeal is taken: Name and mailing of address of affiant/prosecutor as shown on citation or complaint (arresting officer) If sentence includes fines and costs, amount paid, if any: Type or amount of bail furnished to issuing authority, if any: Name and address of attorney for defendant, if any: I.D.#: Name and address of issuing authority (District Justice) Printed name: Address: Zip Zip Signature: NOTE: If appeal is filed by an attorney, signature indicates entry of appearance for purposes of appeal. I hereby acknowledge personal service of a copy of this notice scheduling a SUMMARY COURT HEARING before Judge on , 20 , at a.m. in Courtroom No. ______, County Courthouse, Washington, PA. If I cannot attend this scheduled hearing, I will seek a continuance. If a continuance is granted, I will notify the District Attorney of continuance in writing. Should I secure the services of counsel, I will notify said counsel of this hearing and advise counsel that he must enter an appearance for me to receive hearing notices. Sworn to and subscribed before me This ________ day of _________________, 20 _____ APPELLANT/ATTORNEY NOTICE TO DEFT.: IF APPEAL IS FROM MOTOR VEHICLE CONVICTION OTHER THAN PARKING, YOU MAY ASK FOR A CERTIFIED COPY OF THIS APPEAL WHICH YOU SHOULD MAIL TO: PA DEPT. OF TRANSPORTATION, BUREAU OF LICENSING, P.O. BOX 60037, HARRISBURG, PA 17106 BARBARA GIBBS, CLERK OF COURTS Washington County, Pennsylvania My term expires: 1st Monday of January, 20 SERVICE Fax *Issuing Authority: ___________________Mail District Attorney *Affiant: # NOTE: *Service, the above date unless otherwise specified and by Certified mail, Return Receipt Requested. Filing Fee: Check Cash American LegalNet, Inc. www.FormsWorkflow.com