[ { "page": 1, "items": [ { "page": 1, "type": "TITLE", "location": { "l": 85.68, "t": 756, "r": 524.64, "b": 728.64 }, "text": "IN THE COURT OF COMMON PLEAS OF ADAMS COUNTY, PENNSYLVANIA\nCIVIL ACTION – LAW", "reading_order": 0, "level": 1 }, { "page": 1, "type": "TEXT", "location": { "l": 67.68, "t": 707.52, "r": 502.56, "b": 687.66 }, "text": "Name Plaintiff Case No.", "reading_order": 1 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 72, "t": 724.32, "r": 270.292, "b": 702.12 }, "text": "Name(EOAForm)", "field_kind": "text", "label": "Name(EOAForm)", "pdf_field_name": "Name(EOAForm)", "pdf_field_type": "Text", "reading_order": 2 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 369.24, "t": 710.52, "r": 501.36, "b": 688.32 }, "text": "Case No(EOAForm)", "field_kind": "text", "label": "Case No(EOAForm)", "pdf_field_name": "Case No(EOAForm)", "pdf_field_type": "Text", "reading_order": 3 }, { "page": 1, "type": "FIGURE", "location": { "l": 67.68, "t": 687.66, "r": 502.56, "b": 667.8 }, "text": "", "reading_order": 4 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 72, "t": 669.12, "r": 269.41, "b": 646.92 }, "text": "Name_2(EOAForm)", "field_kind": "text", "label": "Name_2(EOAForm)", "pdf_field_name": "Name_2(EOAForm)", "pdf_field_type": "Text", "reading_order": 5 }, { "page": 1, "type": "TEXT", "location": { "l": 67.68, "t": 647.94, "r": 502.56, "b": 628.08 }, "text": "Name Defendant :", "reading_order": 6 }, { "page": 1, "type": "TEXT", "location": { "l": 34.08, "t": 582.24, "r": 121.2, "b": 570 }, "text": "To the Prothonotary:", "reading_order": 7 }, { "page": 1, "type": "TITLE", "location": { "l": 135.36, "t": 618.72, "r": 474.96, "b": 591.6 }, "text": "ENTRY OF APPEARANCE OF SELF-REPRESENTED PARTY\nPURSUANT TO Pa.R.C.P. 1930.8", "reading_order": 8, "level": 1 }, { "page": 1, "type": "TEXT", "location": { "l": 33.12, "t": 559.44, "r": 257.76, "b": 546.72 }, "text": "Please enter my appearance as a self-represented party.", "reading_order": 9 }, { "page": 1, "type": "LIST_ITEM", "location": { "l": 34.32, "t": 533.52, "r": 420.48, "b": 521.28 }, "text": "1. I am the Plaintiff, Defendant, or Other in the above captioned action. (select one)", "marker": "1.", "list_id": "L1", "level": 0, "reading_order": 10 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 87.0569, "t": 535.666, "r": 102.825, "b": 520.642 }, "text": "my", "field_kind": "checkbox", "label": "my", "pdf_field_name": "Check Box1(EOAForm)", "pdf_field_type": "CheckBox", "reading_order": 11 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 139.515, "t": 535.293, "r": 153.422, "b": 520.642 }, "text": "appearance", "field_kind": "checkbox", "label": "appearance", "pdf_field_name": "Check Box2(EOAForm)", "pdf_field_type": "CheckBox", "reading_order": 12 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 209.458, "t": 535.294, "r": 224.481, "b": 519.154 }, "text": "self-represented", "field_kind": "checkbox", "label": "self-represented", "pdf_field_name": "Check Box3(EOAForm)", "pdf_field_type": "CheckBox", "reading_order": 13 }, { "page": 1, "type": "LIST_ITEM", "location": { "l": 33.84, "t": 512.64, "r": 475.2, "b": 500.16 }, "text": "2. This is a custody, divorce, support, protection from abuse, or paternity case. (select one)", "marker": "2.", "list_id": "L2", "level": 0, "reading_order": 14 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 88.5451, "t": 514.087, "r": 103.196, "b": 499.808 }, "text": "my", "field_kind": "checkbox", "label": "my", "pdf_field_name": "Check Box4(EOAForm)", "pdf_field_type": "CheckBox", "reading_order": 15 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 137.654, "t": 514.087, "r": 153.05, "b": 499.436 }, "text": "appearance", "field_kind": "checkbox", "label": "appearance", "pdf_field_name": "Check Box5(EOAForm)", "pdf_field_type": "CheckBox", "reading_order": 16 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 185.647, "t": 514.087, "r": 201.414, "b": 499.436 }, "text": "Defendant,", "field_kind": "checkbox", "label": "Defendant,", "pdf_field_name": "Check Box6(EOAForm)", "pdf_field_type": "CheckBox", "reading_order": 17 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 234.012, "t": 513.715, "r": 250.151, "b": 499.064 }, "text": "Other", "field_kind": "checkbox", "label": "Other", "pdf_field_name": "Check Box7(EOAForm)", "pdf_field_type": "CheckBox", "reading_order": 18 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 351.204, "t": 513.715, "r": 366.599, "b": 498.692 }, "text": "action.", "field_kind": "checkbox", "label": "action.", "pdf_field_name": "Check Box8(EOAForm)", "pdf_field_type": "CheckBox", "reading_order": 19 }, { "page": 1, "type": "LIST_ITEM", "location": { "l": 33.84, "t": 492.48, "r": 282.96, "b": 480 }, "text": "Select from one of the following three options, a, b, or c:", "marker": "3.", "list_id": "L3", "level": 0, "items": [ { "page": 1, "type": "LIST_ITEM", "location": { "l": 68.88, "t": 466.56, "r": 568.32, "b": 441.12 }, "text": "I do not currently have an attorney representing me, I have decided not to hire an attorney to represent me, and I am representing myself in this case.", "marker": "a.", "list_id": "L3", "level": 1, "reading_order": 0 } ], "reading_order": 20 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 87.0569, "t": 470.187, "r": 103.196, "b": 454.048 }, "text": "a. □ I do not currently have an attorney representing me, I have decided not to hire an attorney to represent me, and I am", "field_kind": "checkbox", "label": "a. □ I do not currently have an attorney representing me, I have decided not to hire an attorney to represent me, and I am", "pdf_field_name": "Check Box9(EOAForm)", "pdf_field_type": "CheckBox", "reading_order": 21 }, { "page": 1, "type": "LIST_ITEM", "location": { "l": 68.16, "t": 427.68, "r": 554.4, "b": 401.28 }, "text": "b. ___ is my attorney of record and I want to terminate the services of my attorney and proceed as a self-represented party. I will provide notice to my attorney.", "marker": "b.", "list_id": "L4", "level": 0, "reading_order": 22 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 103.32, "t": 439.56, "r": 398.4, "b": 417.36 }, "text": "Attorney(EOAForm)", "field_kind": "text", "label": "Attorney(EOAForm)", "pdf_field_name": "Attorney(EOAForm)", "pdf_field_type": "Text", "reading_order": 23 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 84.0806, "t": 432.24, "r": 100.22, "b": 414.612 }, "text": "b. □ ___________________________________________________________ is my attorney of record and I want to", "field_kind": "checkbox", "label": "b. □ ___________________________________________________________ is my attorney of record and I want to", "pdf_field_name": "Check Box10(EOAForm)", "pdf_field_type": "CheckBox", "reading_order": 24 }, { "page": 1, "type": "LIST_ITEM", "location": { "l": 68.16, "t": 387.6, "r": 562.08, "b": 338.16 }, "text": "c. I am entering my appearance as a self-represented party (sign)_____, and my attorney acknowledges his/her withdrawal as my attorney of record in this case. (Attorney signature)", "marker": "c.", "list_id": "L5", "level": 0, "reading_order": 25 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 85.5687, "t": 392.059, "r": 102.824, "b": 375.548 }, "text": "c. □ I am entering my appearance as a self-represented party (sign) _________________________________________,", "field_kind": "checkbox", "label": "c. □ I am entering my appearance as a self-represented party (sign) _________________________________________,", "pdf_field_name": "Check Box11(EOAForm)", "pdf_field_type": "CheckBox", "reading_order": 26 }, { "page": 1, "type": "LIST_ITEM", "location": { "l": 33.12, "t": 329.52, "r": 569.52, "b": 270.24 }, "text": "4. NOTE: You must provide the Court with an address where you agree that pleadings and other legal papers may be served, and a telephone number through which you may be contacted. The address and phone number that you provide need not be your home address and phone number. If this is a protection from abuse (PFA) case or other case where the confidentiality of your home address and phone number is essential, please use an alternate address and phone number where you may be served by mail and contacted by telephone.", "marker": "4.", "list_id": "L6", "level": 0, "reading_order": 27 }, { "page": 1, "type": "TEXT", "location": { "l": 51.6, "t": 260.4, "r": 264.72, "b": 247.92 }, "text": "Papers may be served at the address set forth below:", "reading_order": 28 }, { "page": 1, "type": "TEXT", "location": { "l": 67.68, "t": 258, "r": 284.4, "b": 142.56 }, "text": "Name of Party\nStreet Address\nCity State Z", "reading_order": 29 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 72, "t": 247.32, "r": 282, "b": 225.12 }, "text": "Name of Party(EOAForm)", "field_kind": "text", "label": "Name of Party(EOAForm)", "pdf_field_name": "Name of Party(EOAForm)", "pdf_field_type": "Text", "reading_order": 30 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 72, "t": 212.52, "r": 282, "b": 190.32 }, "text": "Street Address(EOAForm)", "field_kind": "text", "label": "Street Address(EOAForm)", "pdf_field_name": "Street Address(EOAForm)", "pdf_field_type": "Text", "reading_order": 31 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 72, "t": 178.08, "r": 175.2, "b": 155.88 }, "text": "City(EOAForm)", "field_kind": "text", "label": "City(EOAForm)", "pdf_field_name": "City(EOAForm)", "pdf_field_type": "Text", "reading_order": 32 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 180, "t": 178.08, "r": 211.2, "b": 155.88 }, "text": "State(EOAForm)", "field_kind": "text", "label": "State(EOAForm)", "pdf_field_name": "State(EOAForm)", "pdf_field_type": "Text", "reading_order": 33 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 216, "t": 178.08, "r": 282, "b": 155.88 }, "text": "Zip Code(EOAForm)", "field_kind": "text", "label": "Zip Code(EOAForm)", "pdf_field_name": "Zip Code(EOAForm)", "pdf_field_type": "Text", "reading_order": 34 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 324, "t": 247.32, "r": 540, "b": 225.12 }, "text": "Home Phone Number – include area code(EOAForm)", "field_kind": "text", "label": "Home Phone Number – include area code(EOAForm)", "pdf_field_name": "Home Phone Number include area code(EOAForm)", "pdf_field_type": "Text", "reading_order": 35 }, { "page": 1, "type": "TEXT", "location": { "l": 322.08, "t": 223.44, "r": 493.44, "b": 211.68 }, "text": "Home Phone Number – include area code", "reading_order": 36 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 324, "t": 212.52, "r": 538.92, "b": 190.32 }, "text": "Cell Phone Number – include area code(EOAForm)", "field_kind": "text", "label": "Cell Phone Number – include area code(EOAForm)", "pdf_field_name": "Cell Phone Number include area code(EOAForm)", "pdf_field_type": "Text", "reading_order": 37 }, { "page": 1, "type": "TEXT", "location": { "l": 322.08, "t": 189.12, "r": 485.76, "b": 177.36 }, "text": "Cell Phone Number – include area code", "reading_order": 38 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 324, "t": 178.08, "r": 538.92, "b": 155.88 }, "text": "Fax Number (optional) – include area code", "field_kind": "text", "label": "Fax Number (optional) – include area code", "pdf_field_name": "Fax Number optional include area code", "pdf_field_type": "Text", "reading_order": 39 }, { "page": 1, "type": "TEXT", "location": { "l": 178.32, "t": 154.32, "r": 498.72, "b": 142.32 }, "text": "State Zip Code Fax Number (optional) – include area code", "reading_order": 40 }, { "page": 1, "type": "LIST_ITEM", "location": { "l": 34.08, "t": 129.12, "r": 550.32, "b": 105.12 }, "text": "5. I understand that I must file this form in the Prothonotary’s Office and that I must file a new form every time my address or telephone number changes. Please see Pennsylvania Rule of Civil Procedure 1930.8 for more information.", "marker": "5.", "list_id": "L7", "level": 0, "reading_order": 41 }, { "page": 1, "type": "TEXT", "location": { "l": 70.56, "t": 75.36, "r": 283.2, "b": 66.72 }, "text": "___", "reading_order": 42 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 72, "t": 93.12, "r": 282, "b": 70.92 }, "text": "DATE(EOAForm)", "field_kind": "text", "label": "DATE(EOAForm)", "pdf_field_name": "DATE(EOAForm)", "pdf_field_type": "Text", "reading_order": 43 }, { "page": 1, "type": "TEXT", "location": { "l": 67.92, "t": 69.12, "r": 283.2, "b": 53.52 }, "text": "DATE", "reading_order": 44 }, { "page": 1, "type": "TEXT", "location": { "l": 322.08, "t": 68.64, "r": 393.36, "b": 56.16 }, "text": "SIGNATURE", "reading_order": 45 } ] } ]