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\"Image\"
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" }, { "id": "p1.6", "order": 20, "type": "title", "bbox": { "l": 102.24, "t": 656.64, "r": 488.16, "b": 642 }, "text": "ENTRY OF APPEARANCE AS A SELF-REPRESENTED PARTY", "attrs": { "block_label": "doc_title" }, "level": 2 }, { "id": "p1.7", "order": 21, "type": "list", "bbox": { "l": 41.28, "t": 633.12, "r": 501.36, "b": 601.68 }, "text": "", "attrs": { "item_count": 2 }, "children": [ { "id": "p1.7.1", "order": 22, "type": "list_item", "bbox": { "l": 42, "t": 633.12, "r": 315.84, "b": 621.36 }, "text": "I am the ___ Plaintiff ___ Defendant in the above-captioned case.", "marker": "1." }, { "id": "p1.7.2", "order": 23, "type": "list_item", "bbox": { "l": 41.28, "t": 613.92, "r": 501.36, "b": 601.68 }, "text": "I intend to represent myself in the ___ custody, ___ divorce, ___ support, ___ protection from abuse, ___ paternity case.", "marker": "2." }, { "id": "p1.7.3", "order": 24, "type": "form_field", "bbox": { "l": 110.867, "t": 632.396, "r": 119.194, "b": 623.697 }, "text": "", "attrs": { "field_kind": "checkbox", "pdf_field_name": "Check Box3(EOAForm)", "source": "acroform" } }, { "id": "p1.7.4", "order": 25, "type": "form_field", "bbox": { "l": 154.768, "t": 632.396, "r": 163.095, "b": 624.069 }, "text": "", "attrs": { "field_kind": "checkbox", "pdf_field_name": "Check Box4(EOAForm)", "source": "acroform" } }, { "id": "p1.7.5", "order": 26, "type": "form_field", "bbox": { "l": 203.505, "t": 612.678, "r": 211.832, "b": 604.351 }, "text": "", "attrs": { "field_kind": "checkbox", "pdf_field_name": "Check Box5(EOAForm)", "source": "acroform" } }, { "id": "p1.7.6", "order": 27, "type": "form_field", "bbox": { "l": 248.894, "t": 612.678, "r": 257.22, "b": 604.351 }, "text": "", "attrs": { "field_kind": "checkbox", "pdf_field_name": "Check Box6(EOAForm)", "source": "acroform" } }, { "id": "p1.7.7", "order": 28, "type": "form_field", "bbox": { "l": 292.422, "t": 612.678, "r": 300.377, "b": 604.351 }, "text": "", "attrs": { "field_kind": "checkbox", "pdf_field_name": "Check Box7(EOAForm)", "source": "acroform" } }, { "id": "p1.7.8", "order": 29, "type": "form_field", "bbox": { "l": 336.695, "t": 612.306, "r": 345.022, "b": 603.979 }, "text": "", "attrs": { "field_kind": "checkbox", "pdf_field_name": "Check Box8(EOAForm)", "source": "acroform" } }, { "id": "p1.7.9", "order": 30, "type": "form_field", "bbox": { "l": 434.168, "t": 612.306, "r": 442.495, "b": 603.607 }, "text": "", "attrs": { "field_kind": "checkbox", "pdf_field_name": "Check Box9(EOAForm)", "source": "acroform" } } ] }, { "id": "p1.8", "order": 31, "type": "text", "bbox": { "l": 209.04, "t": 593.76, "r": 348.24, "b": 583.2 }, "text": "Check only one box in Question 3" }, { "id": "p1.9", "order": 32, "type": "text", "bbox": { "l": 41.04, "t": 585.12, "r": 498.24, "b": 564.96 }, "text": "3. This is a new case and I am representing myself. I have decided not to hire an attorney to represent me. OR" }, { "id": "p1.10", "order": 33, "type": "text", "bbox": { "l": 74.4, "t": 555.6, "r": 513.84, "b": 534.24 }, "text": "This is not a new case and I am representing myself. I have decided not to hire an attorney to represent me. OR" }, { "id": "p1.11", "order": 34, "type": "text", "bbox": { "l": 74.16, "t": 526.08, "r": 484.32, "b": 514.56 }, "text": "□ This is not a new case. ___ previously" }, { "id": "p1.12", "order": 35, "type": "text", "bbox": { "l": 209.76, "t": 515.04, "r": 283.92, "b": 505.2 }, "text": "(Name of Attorney)" }, { "id": "p1.13", "order": 36, "type": "text", "bbox": { "l": 109.2, "t": 506.64, "r": 468.96, "b": 486.72 }, "text": "represented me in this case. I have decided not to be represented by that attorney and direct the Prothonotary to remove that attorney as my counsel of record in this case." }, { "id": "p1.14", "order": 37, "type": "text", "bbox": { "l": 109.44, "t": 486, "r": 438, "b": 475.68 }, "text": "I have provided a copy of this form to that attorney listed above at the following address:" }, { "id": "p1.15", "order": 38, "type": "text", "bbox": { "l": 108.48, "t": 457.44, "r": 434.64, "b": 446.16 }, "text": "That attorney has acknowledged his/her withdrawal from this case by signing this form." }, { "id": "p1.16", "order": 39, "type": "text", "bbox": { "l": 355.68, "t": 445.92, "r": 375.36, "b": 436.56 }, "text": "Esq." }, { "id": "p1.17", "order": 40, "type": "text", "bbox": { "l": 239.04, "t": 441.12, "r": 372.96, "b": 427.2 }, "text": "(Attorney signature)" }, { "id": "p1.18", "order": 41, "type": "text", "bbox": { "l": 43.44, "t": 418.8, "r": 511.68, "b": 406.56 }, "text": "4. I am entering my appearance as a self-represented party ___" }, { "id": "p1.19", "order": 42, "type": "text", "bbox": { "l": 343.2, "t": 408, "r": 408.24, "b": 397.2 }, "text": "(Your Signature)" }, { "id": "p1.20", "order": 43, "type": "text", "bbox": { "l": 41.76, "t": 388.8, "r": 511.68, "b": 336.96 }, "text": "5. I understand that I need to provide a street address or P.O. Box for the purpose of receiving all future pleadings and other legal notices. I further understand that this does not need to be my home address. My address for the purpose of receiving all future pleadings and other legal notices is:" }, { "id": "p1.21", "order": 44, "type": "text", "bbox": { "l": 73.68, "t": 330.96, "r": 497.76, "b": 299.52 }, "text": "I understand that this address will be the only address to which notices and pleadings in this case will be sent and that I am responsible to check the mail at this address so I do not miss important deadlines or proceedings." }, { "id": "p1.22", "order": 45, "type": "text", "bbox": { "l": 73.92, "t": 291.84, "r": 507.12, "b": 260.64 }, "text": "I am not providing my address because I reside at a confidential location protected by the Protection From Abuse Act, 23 Pa. C.S. § 6112 and/or the Address Confidentiality Program, 23 Pa. C.S. § 6701-6713, and/or the Child Custody Act, 23 Pa. C.S. § 5336(b)." }, { "id": "p1.23", "order": 46, "type": "text", "bbox": { "l": 40.32, "t": 252.72, "r": 439.68, "b": 241.44 }, "text": "6. My telephone number where I can be reached is ___." }, { "id": "p1.24", "order": 47, "type": "text", "bbox": { "l": 73.44, "t": 237.84, "r": 503.76, "b": 216.72 }, "text": "I am not providing my telephone number because it is confidential pursuant to the Protection From Abuse Act, 23 Pa. C.S. § 6112 and/or the Child Custody Act, 23 Pa. C.S. § 5336(c)." }, { "id": "p1.25", "order": 48, "type": "list", "bbox": { "l": 40.08, "t": 204.24, "r": 515.76, "b": 163.2 }, "text": "", "attrs": { "item_count": 2 }, "children": [ { "id": "p1.25.1", "order": 49, "type": "list_item", "bbox": { "l": 40.08, "t": 204.24, "r": 515.76, "b": 193.2 }, "text": "I UNDERSTAND I MUST FILE A NEW FORM EVERY TIME MY ADDRESS OR TELEPHONE NUMBER CHANGES.", "marker": "7." }, { "id": "p1.25.2", "order": 50, "type": "list_item", "bbox": { "l": 40.56, "t": 184.56, "r": 492.48, "b": 163.2 }, "text": "I understand that I must ensure that a copy of this form is served on all other attorneys or other self-represented parties at the following addresses as listed below: (Use reverse side if you need more space)", "marker": "8." } ] }, { "id": "p1.26", "order": 51, "type": "figure", "bbox": { "l": 0.48, "t": 197.8201, "r": 611.52, "b": -0.0599 }, "text": "", "attrs": { "source": "pdf_image" }, "children": [ { "id": "p1.26.1", "order": 52, "type": "form_field", "bbox": { "l": 132, "t": 163.68, "r": 272.64, "b": 145.44 }, "text": "", "attrs": { "field_kind": "text", "pdf_field_name": "Name1(EOAForm)", "source": "acroform" } }, { "id": "p1.26.2", "order": 53, "type": "form_field", "bbox": { "l": 308.792, "t": 163.628, "r": 504.924, "b": 146.464 }, "text": "", "attrs": { "field_kind": "text", "pdf_field_name": "Address1(EOAForm)", "source": "acroform" } }, { "id": "p1.26.3", "order": 54, "type": "form_field", "bbox": { "l": 308.792, "t": 144.654, "r": 504.924, "b": 127.118 }, "text": "", "attrs": { "field_kind": "text", "pdf_field_name": "Address2(EOAForm)", "source": "acroform" } }, { "id": "p1.26.4", "order": 55, "type": "form_field", "bbox": { "l": 132, "t": 144.24, "r": 272.64, "b": 126 }, "text": "", "attrs": { "field_kind": "text", "pdf_field_name": "Name2(EOAForm)", "source": "acroform" } }, { "id": "p1.26.5", "order": 56, "type": "form_field", "bbox": { "l": 75.84, "t": 86.88, "r": 173.76, "b": 68.64 }, "text": "", "attrs": { "field_kind": "text", "pdf_field_name": "Date(EOAForm)", "source": "acroform" } } ] }, { "id": "p1.27", "order": 57, "type": "text", "bbox": { "l": 106.8, "t": 155.76, "r": 506.4, "b": 144.48 }, "text": "Name_____ Address_____" }, { "id": "p1.28", "order": 58, "type": "text", "bbox": { "l": 106.8, "t": 136.32, "r": 505.92, "b": 124.8 }, "text": "Name_____ Address_____" }, { "id": "p1.29", "order": 59, "type": "text", "bbox": { "l": 40.32, "t": 116.88, "r": 504, "b": 86.16 }, "text": "9. I verify that the statements made in this Entry of Appearance as a Self-Represented Party are true and correct. I understand that if I make false statements herein, that I am subject to the criminal penalties of 18 Pa. C.S. § 4904 relating to unsworn falsification to authorities that could result in a fine and/or prison term." }, { "id": "p1.30", "order": 60, "type": "text", "bbox": { "l": 74.4, "t": 68.16, "r": 175.2, "b": 57.36 }, "text": "I am a" }, { "id": "p1.31", "order": 61, "type": "text", "bbox": { "l": 74.4, "t": 67.2, "r": 95.28, "b": 57.36 }, "text": "Date" }, { "id": "p1.32", "order": 62, "type": "footer", "bbox": { "l": 244.32, "t": 67.92, "r": 308.4, "b": 56.88 }, "text": "(Your Signature)", "attrs": { "block_label": "footer" } } ], "excluded_furniture": { "first": [], "last": [] } }