04/01/2015 Administrative Office of Pennsylvania Courts PUBLIC ACCESS NONRECURRING REQUEST FORM Name_______________________________________________________ Mailing Address:______________________________________________ ____________________________________________________________ City ___________________________ State________ Zip_____________ SUBMIT TO: Administrative Office of Pennsylvania Courts Information Technology � Public Access Unit PO Box 62307 Harrisburg, PA 17106-2307 Phone: 717-795-2000 Fax: 717-795-2002 E-Mail: ediin@pacourts.us Email _______________________________________________ Phone___________________ Fax_______________________ DESCRIPTION OF REQUEST To Be Completed by Administrative Office of Pennsylvania Courts (AOPC) TASK SCOPE Staff Time ($80 per Hour): TOTAL DUE: $ COST REMARKS Notes: � Costs are estimates. If it is determined that actual costs will exceed the estimate, you will be contacted for approval. � A minimum charge of 1 hour of staff time shall be assessed to each request, and thereafter requesters will be charged in 15 minute increments. Disclaimer Information and Receipt of Information are subject to all relevant legal authority as well as the following: 1. 2. A copy of this information may be supplied to the court related to this request. The case information contained in the Pennsylvania Appellate Court Management System (PACMS), Common Pleas Criminal Court Case Management System (CPCMS), and Magisterial District Judge Automated System (MDJS) is not supported by fingerprints. Therefore, it should not be used for the purposes of linking cases to specific individuals. The AOPC will not automatically update the information contained in the PACMS, CPCMS, or MDJS. Recipient acknowledges responsibility to comply with all orders to expunge or correct the data provided. The UJS and AOPC makes no representation as to the accuracy, completeness or utility, for any general or specific purpose, of the information provided and as such, assumes no liability for inaccurate or delayed data, errors or omissions. Use of this information is at the risk of the requestor. Your request for information is being fulfilled consistent with the provisions of the UJS Electronic Case Record Public Access Policy. By submitting this request, I agree to pay any costs incurred and understand that I will not receive the information described above unless or until I make payment as set forth above. 3. 4. 5. 6. 7. SIGNATURE______________________________________________________________ DATE_____________________ 1 American LegalNet, Inc. www.FormsWorkFlow.com