CONFIDENTIAL DOCUMENT FORM Case Records (Party name as displayed in case caption) Docket/Case No. Vs. (Party name as displayed in case caption) Court This form is associated the pleading titled , dated , .Pursuant to the , theConfidential Document Form afiling where a confidential document is required by law, ordered by the court, or isotherwise necessary to effect disposition of a matter.Thisform shall be accessible to the public however the documents attached not be publicly accessible, exceptas ordered by a court.Thedocuments attached will be available to the parties, counsel of record, the court, and the custodian. Please only attach documents necessary for the purposes of this case. Complete the entire form and check all that apply. This form and must beserved on all unrepresented parties and counsel of record. Type of Confidential Document age, etc. where the confidentialdocument is referenced in the filing: Financial Source Documents Tax Returns and schedules W - 2 forms and schedules including 1099 forms or similar documents Wage stubs, earning statements, or other similar documents Credit card statements Financial institution statements (e.g., investment/bank statements) Check registers Checks or equivalent Loan application documents Medical/Psychological records Chil Marital Property Inventory and Pre - Trial Statement as provided in Pa.R.C.P. No. 1920.33 Income and Expense Statement as provided in Pa.R.C.P. No. 1910.27(c) Agreements between the parties as used in 23 Pa.C.S. 2473105 I certify that this filing complies with the provisions of the that require filing anddocuments differently than non-confidential information and documents. Signature of Attorney o Date Name: Attorney Number: (if applicable) Address: Telephone: Email: 204 Pa. Code 247 213.81 American LegalNet, Inc. www.FormsWorkFlow.com CONFIDENTIAL DOCUMENT FORM Instructions for Completing the Confidential Document Form The following documents are confidential and shall be filed with a court or custodian Document Financial Source Documents as listed on the form educational recordsMedical/Psychological relating to the past, present,or future physical or mental health or condition of an Children and Youth recordsMarital Property Inventory and Pre-Trial Statement as provided inNo.1920.33Income and Expense Statement as provided in Pa.R.C.P. No. 1910.27(c)Agreements between the parties as used in 23 Pa.C.S. 2473105 Please only attach documents necessary for the purposes of this case.Complete the entire form and check all that apply. This form must be served on all unrepresented parties and counselofrecord. A court or custodian is not required to review or redact any filed documentfor compliance with the . A or failureto comply shall not affect access to case records that are otherwiseaccessible. If a filed document fails to comply with the above referenced policy, a court may, upon motion or itsown initiative, with or without a hearingorder the filed document sealed costs necessary toprepare for filing inaccordance with applicable authority. American LegalNet, Inc. www.FormsWorkFlow.com