COMMONWEALTH OF PENNSYLVANIA COURT OF COMMON PLEAS Judicial District, County Of NOTICE OF APPEAL FROM MAGISTERIAL DISTRICT JUDGE JUDGMENT COMMON PLEAS No. NOTICE OF APPEAL Notice is given that the appellant has filed in the above Court of Common Pleas an appeal from the judgment rendered by the Magisterial District Judge on the date and in the case referenced below. NAME OF APPELLANT MAG. DIST. NO. NAME OF MDJ ADDRESS OF APPELLANT CITY STATE ZIP CODE DATE OF JUDGMENT IN THE CASE OF ( Plaintiff) (Defendant)` vs SIGNATURE OF APPELLANT OR ATTORNEY OR AGENT DOCKET No. This block will be signed ONLY when this notation is required under Pa. R.C.P.D.J. No. 1008B. This Notice of Appeal, when received by the Magisterial District Judge , will operate as a SUPERSEDEAS to the judgment for possession in this case. If appellant was Claimant (see Pa. R.C.P.D.J. No. 1001(6) in action before a Magisterial District Judge, A COMPLAINT MUST BE FILED within twenty (20) days after filing the NOTICE of APPEAL. Signature of Prothonotary or Deputy PRAECIPE TO ENTER RULE TO FILE COMPLAINT AND RULE TO FILE (This section of form to be used ONLY when appellant was DEFENDANT (see Pa.R.C.P.D.J. No. 1001(7) in action before Magisterial District Judge. IF NOT USED, detach from copy of notice of appeal to be served upon appellee. PRAECIPE: To Prothonotary Enter rule upon Name of appellee(s) appellee(s), to file a complaint in this appeal (Common Pleas No. ) within twenty (20) days after service of rule or suffer entry of judgment of non pros. __________________________________________________ Signature of appellant or attorney or agent RULE: To Name of appellee(s) , appellee(s) (1) You are notified that a rule is hereby entered upon you to file a complaint in this appeal within twenty (20) days after the date of service of this rule upon you by personal service or by certified or registered mail. (2) If you do not file a complaint within this time, a JUDGMENT OF NON PROS MAY BE ENTERED AGAINST YOU. (3) The date of service of this rule if service was by mail is the date of the mailing. Date: , 20 __________________________________________ Signature of Prothonotary or Deputy YOU MUST INCLUDE A COPY OF THE NOTICE OF JUDGMENT/TRANSCRIPT FORM WITH THIS NOTICE OF APPEAL. The appellee and the magisterial district judge in whose office the judgment was rendered must be served with a copy of this Notice pursuant to Pa.R.C.P.M.D.J. 1005(A). AOPC 312-05 American LegalNet, Inc. www.FormsWorkFlow.com PROOF OF SERVICE OF NOTICE OF APPEAL AND RULE TO FILE COMPLAINT (This proof of service MUST BE FILED WITHIN TEN (10) DAYS AFTER filing of the notice of appeal. Check applicable boxes.) COMMONWEALTH OF PENNSYLVANIA COUNTY OF ; ss __ __ _ _ _ __ _ _ _ _ _ _ __ _ _ _ _ _ _ __ _ _ _ __ _ _ _ _ _ __ _ _ _ _ __ _ _ _ _ _ __ _ _ _ _ _ _ __ _ _ _ __ _ _ _ _ _ _ __ _ _ _ __ _ _ _ _ _ _ __ _ _ _ _ _ __ _ _ _ __ _ _ _ _ _ _ __ _ __ __ _ _ _ _ _ _ __ _ _ _ __ _ _ _ _ _ _ __ _ _ _ __ _ _ _ _ _ _ __ _ _ _ _ _ __ _ _ _ __ _ _ _ _ _ _ __ _ _ _ __ _ _ _ _ _ _ __ _ _ _ _ _ _ __ _ _ _ __ _ _ _ _ _ __ _ _ _ _ __ _ _ _ _ _ __ _ __ _ _ _ __ _ _ _ _ _ _ __ _ _ _ _ _ __ _ _ _ __ _ _ _ _ _ _ __ _ _ _ __ _ _ _ _ _ __ _ _ __ __ _ _ _ __ _ _ _ _ _ _ __ _ _ _ __ _ _ _ AFFIDAVIT: I hereby (swear) (affirm) that I served a copy of the Notice of Appeal, Common Pleas No. - - -- -- - -- -- - -- -- -- - -- -- - -- -- -- - -- -- -- - -- -- - -- -- -- - -- , upon the Magisterial District Judge designated therein on - -- -- -- - -- -- - -- -- -- - -- -- - -- (date of service) , 20 , by personal service , on by (certified) (registered) mail, sender's receipt attached hereto, and upon the appellee, (name) , 20 by personal service by (certified) (registered) mail, sender's receipt attached hereto. (SWORN) (AFFIRMED) AND SUBSCRIBED BEFORE ME THIS DAY OF , 20 _________________________________________________ ________________ _________________________________ Signature of official before whom affidavit was made Signature of affiant Title of official My commission expires on , 20 AOPC 312A - 05 American LegalNet, Inc. www.FormsWorkFlow.com