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                                "text_offset": 199,
                                "text_span": 1
                            }
                        }
                    ]
                },
                {
                    "id": "p11.3.11",
                    "order": 33,
                    "type": "table_cell",
                    "bbox": {
                        "l": 40.0669,
                        "t": 394.4265,
                        "r": 576.292,
                        "b": 358.1757
                    },
                    "text": "AFTER COMPLETING THE FORM, PLEASE SEND TO: COURT ADA COORDINATOR, 117 Baltimore Street, 4th Floor, Gettysburg, PA 17325 Phone: (717) 337-9846, Fax: (717) 334-8817, Email: courtadacoordinator@adamscountypa.gov",
                    "attrs": {
                        "row": 9,
                        "col": 0,
                        "rowspan": 1,
                        "colspan": 2
                    }
                },
                {
                    "id": "p11.3.12",
                    "order": 34,
                    "type": "table_cell",
                    "bbox": {
                        "l": 40.0669,
                        "t": 358.1757,
                        "r": 576.292,
                        "b": 321.9249
                    },
                    "text": "I hereby certify that an Americans with Disabilities Act accommodation is required in the above-captioned action on the date stated. Signature: _____ Date: _____",
                    "attrs": {
                        "row": 10,
                        "col": 0,
                        "rowspan": 1,
                        "colspan": 2
                    }
                },
                {
                    "id": "p11.3.13",
                    "order": 35,
                    "type": "table_cell",
                    "bbox": {
                        "l": 40.0669,
                        "t": 321.9249,
                        "r": 576.292,
                        "b": 285.6741
                    },
                    "text": "FOR OFFICIAL USE ONLY",
                    "attrs": {
                        "row": 11,
                        "col": 0,
                        "rowspan": 1,
                        "colspan": 2
                    }
                },
                {
                    "id": "p11.3.14",
                    "order": 36,
                    "type": "table_cell",
                    "bbox": {
                        "l": 40.0669,
                        "t": 285.6741,
                        "r": 576.292,
                        "b": 249.4233
                    },
                    "text": "Service Provider Information - Section E",
                    "attrs": {
                        "row": 12,
                        "col": 0,
                        "rowspan": 1,
                        "colspan": 2
                    }
                },
                {
                    "id": "p11.3.15",
                    "order": 37,
                    "type": "table_cell",
                    "bbox": {
                        "l": 40.0669,
                        "t": 249.4233,
                        "r": 576.292,
                        "b": 213.1725
                    },
                    "text": "Service Provider Company: _____ Fax: _____ Individual Interpreter Name: _____ Email: _____ Date to: Provider Name: _____ Provider: _____ Bus. Phone Mobile: _____",
                    "attrs": {
                        "row": 13,
                        "col": 0,
                        "rowspan": 1,
                        "colspan": 2
                    }
                },
                {
                    "id": "p11.3.16",
                    "order": 38,
                    "type": "table_cell",
                    "bbox": {
                        "l": 40.0669,
                        "t": 213.1725,
                        "r": 576.292,
                        "b": 176.9216
                    },
                    "text": "Court Official Verification - Section F",
                    "attrs": {
                        "row": 14,
                        "col": 0,
                        "rowspan": 1,
                        "colspan": 2
                    }
                },
                {
                    "id": "p11.3.17",
                    "order": 39,
                    "type": "table_cell",
                    "bbox": {
                        "l": 40.0669,
                        "t": 176.9216,
                        "r": 576.292,
                        "b": 140.6708
                    },
                    "text": "Verifying Official Shall Maintain a Copy in the Court's Case File and Provide the Original to the Service Provider for Submission with Billing. I hereby verify that the services were performed by the provider in the above-captioned action on the date and time stated.",
                    "attrs": {
                        "row": 15,
                        "col": 0,
                        "rowspan": 1,
                        "colspan": 2
                    }
                },
                {
                    "id": "p11.3.18",
                    "order": 40,
                    "type": "table_cell",
                    "bbox": {
                        "l": 40.0669,
                        "t": 140.6708,
                        "r": 308.1794,
                        "b": 104.42
                    },
                    "text": "Start Date & Time",
                    "attrs": {
                        "row": 16,
                        "col": 0,
                        "rowspan": 1,
                        "colspan": 1
                    }
                },
                {
                    "id": "p11.3.19",
                    "order": 41,
                    "type": "table_cell",
                    "bbox": {
                        "l": 308.1794,
                        "t": 140.6708,
                        "r": 576.292,
                        "b": 104.42
                    },
                    "text": "End Date & Time",
                    "attrs": {
                        "row": 16,
                        "col": 1,
                        "rowspan": 1,
                        "colspan": 1
                    }
                },
                {
                    "id": "p11.3.20",
                    "order": 42,
                    "type": "table_cell",
                    "bbox": {
                        "l": 40.0669,
                        "t": 104.42,
                        "r": 308.1794,
                        "b": 68.1692
                    },
                    "text": "Court Official: _____ Signature: _____ Title: _____ Date: _____",
                    "attrs": {
                        "row": 17,
                        "col": 0,
                        "rowspan": 1,
                        "colspan": 1
                    }
                },
                {
                    "id": "p11.3.21",
                    "order": 43,
                    "type": "table_cell",
                    "bbox": {
                        "l": 308.1794,
                        "t": 104.42,
                        "r": 576.292,
                        "b": 68.1692
                    },
                    "text": "",
                    "attrs": {
                        "row": 17,
                        "col": 1,
                        "rowspan": 1,
                        "colspan": 1
                    }
                },
                {
                    "id": "p11.3.22",
                    "order": 44,
                    "type": "table_cell",
                    "bbox": {
                        "l": 40.0669,
                        "t": 68.1692,
                        "r": 576.292,
                        "b": 31.9184
                    },
                    "text": "(08/14)",
                    "attrs": {
                        "row": 18,
                        "col": 0,
                        "rowspan": 1,
                        "colspan": 2
                    }
                }
            ]
        }
    ],
    "excluded_furniture": {
        "first": [],
        "last": []
    }
}