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# IN THE COURT OF COMMON PLEAS OF ADAMS COUNTY, PENNSYLVANIA CIVIL ACTION – LAW


<table border=1 style='margin: auto; word-wrap: break-word;'><tr><td style='text-align: center; word-wrap: break-word;'>Name</td><td style='text-align: center; word-wrap: break-word;'>Plaintiff</td><td style='text-align: center; word-wrap: break-word;'>Case No.</td></tr><tr><td style='text-align: center; word-wrap: break-word;'>v.</td><td style='text-align: center; word-wrap: break-word;'></td><td style='text-align: center; word-wrap: break-word;'></td></tr><tr><td style='text-align: center; word-wrap: break-word;'></td><td style='text-align: center; word-wrap: break-word;'></td><td style='text-align: center; word-wrap: break-word;'></td></tr><tr><td style='text-align: center; word-wrap: break-word;'>Name</td><td style='text-align: center; word-wrap: break-word;'>Defendant</td><td style='text-align: center; word-wrap: break-word;'>:</td></tr></table>

# ENTRY OF APPEARANCE OF SELF-REPRESENTED PARTY PURSUANT TO Pa.R.C.P. 1930.8

To the Prothonotary:

Please enter my appearance as a self-represented party.

1. I am the Plaintiff, Defendant, or Other in the above captioned action. (select one)

2. This is a custody, divorce, support, protection from abuse, or paternity case. (select one)

3. Select from one of the following three options, a, b, or c:

a. 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.

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.

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)

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.

Papers may be served at the address set forth below:

Name of Party

Street Address

City State Z



State Zip Code

Cell Phone Number – include area code

Fax Number (optional) – include area code

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.

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