COMMONWEALTH OF PENNSYLVANIA COURT OF COMMON PLEAS County Of PLAINTIFF: NAME and ADDRESS VS. DEFENDANT: NAME and ADDRESS Common Pleas Docket No. TENANT'S SUPERSEDEAS AFFIDAVIT (NON-SECTION 8) FILED PURSUANT TO Pa.R.C.P.M.D.J. No. 1008C(2) I, (print name and address here), have filed a notice of appeal from a magisterial district court judgment awarding to my landlord possession of real property that I occupy, and I do not have the financial ability to pay the lesser of three (3) times my monthly rent or the judgment for rent awarded by the magisterial district court. My total household income does not exceed the income limits set forth in the supplemental instructions for obtaining a stay pending appeal and I have completed an in forma pauperis (IFP) affidavit to verify this. I have/have not (cross out the one that does not apply) paid the rent this month. I verify that the statements made in this affidavit are true and correct to the best of my knowledge, information and belief. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. § 4904, relating to unsworn falsification to authorities. __________ Date __________________________ SIGNATURE OF TENANT AOPC 312-08 (B) American LegalNet, Inc. www.FormsWorkFlow.com