[
    {
        "page": 1,
        "items": [
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 75.36,
                    "t": 730.32,
                    "r": 507.36,
                    "b": 705.84
                },
                "text": "IN THE COURT OF COMMON PLEAS COUNTY, PENNSYLVANIA",
                "reading_order": 0
            },
            {
                "page": 1,
                "type": "FORM_FIELD",
                "location": {
                    "l": 77.76,
                    "t": 739.44,
                    "r": 292.8,
                    "b": 721.2
                },
                "text": "PLAINTIFF(EOAForm)",
                "field_kind": "text",
                "label": "PLAINTIFF(EOAForm)",
                "pdf_field_name": "PLAINTIFF(EOAForm)",
                "pdf_field_type": "Text",
                "reading_order": 1
            },
            {
                "page": 1,
                "type": "FORM_FIELD",
                "location": {
                    "l": 304.8,
                    "t": 718.08,
                    "r": 379.2,
                    "b": 706.08
                },
                "text": "County(EOAForm)",
                "field_kind": "text",
                "label": "County(EOAForm)",
                "pdf_field_name": "County(EOAForm)",
                "pdf_field_type": "Text",
                "reading_order": 2
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 77.52,
                    "t": 729.84,
                    "r": 492.48,
                    "b": 717.84
                },
                "text": "___",
                "reading_order": 3
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 76.08,
                    "t": 717.6,
                    "r": 292.56,
                    "b": 674.64
                },
                "text": "PLAINTIFF\nVS.\nNO. ___",
                "reading_order": 4
            },
            {
                "page": 1,
                "type": "FORM_FIELD",
                "location": {
                    "l": 77.76,
                    "t": 696,
                    "r": 292.8,
                    "b": 677.76
                },
                "text": "Defendant(EOAForm)",
                "field_kind": "text",
                "label": "Defendant(EOAForm)",
                "pdf_field_name": "Defendant(EOAForm)",
                "pdf_field_type": "Text",
                "reading_order": 5
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 299.52,
                    "t": 696.96,
                    "r": 458.88,
                    "b": 684.48
                },
                "text": "<div style=\"text-align: center;\"><img src=\"imgs/img_in_image_box_22_11_634_69.jpg\" alt=\"Image\" width=\"87%\" /></div>\n\n\n<div style=\"text-align: center;\"><img src=\"imgs/img_in_image_box_603_11_691_64.jpg\" alt=\"Image\" width=\"12%\" /></div>\n",
                "reading_order": 6
            },
            {
                "page": 1,
                "type": "FORM_FIELD",
                "location": {
                    "l": 321.12,
                    "t": 705.36,
                    "r": 456.48,
                    "b": 687.12
                },
                "text": "DocketNumber(EOAForm)",
                "field_kind": "text",
                "label": "DocketNumber(EOAForm)",
                "pdf_field_name": "DocketNumber(EOAForm)",
                "pdf_field_type": "Text",
                "reading_order": 7
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 76.08,
                    "t": 677.52,
                    "r": 130.32,
                    "b": 666.48
                },
                "text": "DEFENDANT",
                "reading_order": 8
            },
            {
                "page": 1,
                "type": "TITLE",
                "location": {
                    "l": 102.24,
                    "t": 656.64,
                    "r": 488.16,
                    "b": 642
                },
                "text": "ENTRY OF APPEARANCE AS A SELF-REPRESENTED PARTY",
                "reading_order": 9,
                "level": 1
            },
            {
                "page": 1,
                "type": "LIST_ITEM",
                "location": {
                    "l": 42,
                    "t": 633.12,
                    "r": 315.84,
                    "b": 621.36
                },
                "text": "I am the ___ Plaintiff ___ Defendant in the above-captioned case.",
                "marker": "1.",
                "list_id": "L1",
                "level": 0,
                "reading_order": 10
            },
            {
                "page": 1,
                "type": "LIST_ITEM",
                "location": {
                    "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.",
                "list_id": "L1",
                "level": 0,
                "reading_order": 11
            },
            {
                "page": 1,
                "type": "LIST_ITEM",
                "location": {
                    "l": 209.04,
                    "t": 593.76,
                    "r": 348.24,
                    "b": 583.2
                },
                "text": "Check only one box in Question 3",
                "list_id": "L1",
                "level": 0,
                "reading_order": 12
            },
            {
                "page": 1,
                "type": "LIST_ITEM",
                "location": {
                    "l": 41.04,
                    "t": 585.12,
                    "r": 498.24,
                    "b": 564.96
                },
                "text": "This is a new case and I am representing myself. I have decided not to hire an attorney to represent me. OR",
                "marker": "3.",
                "list_id": "L1",
                "level": 0,
                "reading_order": 13
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "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",
                "reading_order": 14
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 74.16,
                    "t": 526.08,
                    "r": 484.32,
                    "b": 514.56
                },
                "text": "☐ This is not a new case. ___ previously",
                "reading_order": 15
            },
            {
                "page": 1,
                "type": "FORM_FIELD",
                "location": {
                    "l": 200.88,
                    "t": 534.743,
                    "r": 443.444,
                    "b": 516.503
                },
                "text": "Name of Attorney(EOAForm)",
                "field_kind": "text",
                "label": "Name of Attorney(EOAForm)",
                "pdf_field_name": "Name of Attorney(EOAForm)",
                "pdf_field_type": "Text",
                "reading_order": 16
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 209.76,
                    "t": 515.04,
                    "r": 283.92,
                    "b": 505.2
                },
                "text": "(Name of Attorney)",
                "reading_order": 17
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "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.",
                "reading_order": 18
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "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:",
                "reading_order": 19
            },
            {
                "page": 1,
                "type": "FORM_FIELD",
                "location": {
                    "l": 110.4,
                    "t": 476.4,
                    "r": 511.68,
                    "b": 458.16
                },
                "text": "Attorney Address(EOAForm)",
                "field_kind": "text",
                "label": "Attorney Address(EOAForm)",
                "pdf_field_name": "Attorney Address(EOAForm)",
                "pdf_field_type": "Text",
                "reading_order": 20
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "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.",
                "reading_order": 21
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 355.68,
                    "t": 445.92,
                    "r": 375.36,
                    "b": 436.56
                },
                "text": "Esq.",
                "reading_order": 22
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 239.04,
                    "t": 441.12,
                    "r": 372.96,
                    "b": 427.2
                },
                "text": "(Attorney signature)",
                "reading_order": 23
            },
            {
                "page": 1,
                "type": "LIST_ITEM",
                "location": {
                    "l": 43.44,
                    "t": 418.8,
                    "r": 511.68,
                    "b": 406.56
                },
                "text": "I am entering my appearance as a self-represented party ___",
                "marker": "4.",
                "list_id": "L2",
                "level": 0,
                "reading_order": 24
            },
            {
                "page": 1,
                "type": "LIST_ITEM",
                "location": {
                    "l": 343.2,
                    "t": 408,
                    "r": 408.24,
                    "b": 397.2
                },
                "text": "(Your Signature)",
                "list_id": "L2",
                "level": 0,
                "reading_order": 25
            },
            {
                "page": 1,
                "type": "LIST_ITEM",
                "location": {
                    "l": 41.76,
                    "t": 388.8,
                    "r": 511.68,
                    "b": 336.96
                },
                "text": "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:",
                "marker": "5.",
                "list_id": "L2",
                "level": 0,
                "reading_order": 26
            },
            {
                "page": 1,
                "type": "FORM_FIELD",
                "location": {
                    "l": 76.8,
                    "t": 359.04,
                    "r": 492.48,
                    "b": 340.8
                },
                "text": "Address(EOAForm)",
                "field_kind": "text",
                "label": "Address(EOAForm)",
                "pdf_field_name": "Address(EOAForm)",
                "pdf_field_type": "Text",
                "reading_order": 27
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "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.",
                "reading_order": 28
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "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).",
                "reading_order": 29
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 40.32,
                    "t": 252.72,
                    "r": 439.68,
                    "b": 241.44
                },
                "text": "6. My telephone number where I can be reached is ___.",
                "reading_order": 30
            },
            {
                "page": 1,
                "type": "FORM_FIELD",
                "location": {
                    "l": 258.72,
                    "t": 261.84,
                    "r": 435.84,
                    "b": 243.6
                },
                "text": "Phone Number(EOAForm)",
                "field_kind": "text",
                "label": "Phone Number(EOAForm)",
                "pdf_field_name": "Phone Number(EOAForm)",
                "pdf_field_type": "Text",
                "reading_order": 31
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "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).",
                "reading_order": 32
            },
            {
                "page": 1,
                "type": "LIST_ITEM",
                "location": {
                    "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.",
                "list_id": "L3",
                "level": 0,
                "reading_order": 33
            },
            {
                "page": 1,
                "type": "LIST_ITEM",
                "location": {
                    "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.",
                "list_id": "L3",
                "level": 0,
                "reading_order": 34
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 106.8,
                    "t": 155.76,
                    "r": 506.4,
                    "b": 144.48
                },
                "text": "Name_____ Address_____",
                "reading_order": 35
            },
            {
                "page": 1,
                "type": "FORM_FIELD",
                "location": {
                    "l": 132,
                    "t": 163.68,
                    "r": 272.64,
                    "b": 145.44
                },
                "text": "Name1(EOAForm)",
                "field_kind": "text",
                "label": "Name1(EOAForm)",
                "pdf_field_name": "Name1(EOAForm)",
                "pdf_field_type": "Text",
                "reading_order": 36
            },
            {
                "page": 1,
                "type": "FORM_FIELD",
                "location": {
                    "l": 308.792,
                    "t": 163.628,
                    "r": 504.924,
                    "b": 146.464
                },
                "text": "Address1(EOAForm)",
                "field_kind": "text",
                "label": "Address1(EOAForm)",
                "pdf_field_name": "Address1(EOAForm)",
                "pdf_field_type": "Text",
                "reading_order": 37
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 106.8,
                    "t": 136.32,
                    "r": 505.92,
                    "b": 124.8
                },
                "text": "Name_____ Address_____",
                "reading_order": 38
            },
            {
                "page": 1,
                "type": "FORM_FIELD",
                "location": {
                    "l": 308.792,
                    "t": 144.654,
                    "r": 504.924,
                    "b": 127.118
                },
                "text": "Address2(EOAForm)",
                "field_kind": "text",
                "label": "Address2(EOAForm)",
                "pdf_field_name": "Address2(EOAForm)",
                "pdf_field_type": "Text",
                "reading_order": 39
            },
            {
                "page": 1,
                "type": "FORM_FIELD",
                "location": {
                    "l": 132,
                    "t": 144.24,
                    "r": 272.64,
                    "b": 126
                },
                "text": "Name2(EOAForm)",
                "field_kind": "text",
                "label": "Name2(EOAForm)",
                "pdf_field_name": "Name2(EOAForm)",
                "pdf_field_type": "Text",
                "reading_order": 40
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "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.",
                "reading_order": 41
            },
            {
                "page": 1,
                "type": "FORM_FIELD",
                "location": {
                    "l": 75.84,
                    "t": 86.88,
                    "r": 173.76,
                    "b": 68.64
                },
                "text": "Date(EOAForm)",
                "field_kind": "text",
                "label": "Date(EOAForm)",
                "pdf_field_name": "Date(EOAForm)",
                "pdf_field_type": "Text",
                "reading_order": 42
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 74.4,
                    "t": 68.16,
                    "r": 175.2,
                    "b": 57.36
                },
                "text": "I am a",
                "reading_order": 43
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 74.4,
                    "t": 67.2,
                    "r": 95.28,
                    "b": 57.36
                },
                "text": "Date",
                "reading_order": 44
            }
        ]
    }
]