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Certificate of Service
Form 11
Form 11 – Certificate of Service
The numbers on these instructions correspond with the numbers in the boxes on the form. Use the form with the boxes to guide you through filling out the blank form.
Box 1: Print the name of the county in which you filed exactly as you wrote it on Form 1.
Box 2: Print the name of the Plaintiff exactly as it appears on Form 1.
Box 3: Print the docket number that the Prothonotary's Office wrote on Form 1 at the time of filing.
Box 4: Print the name of the Defendant exactly as it appears on Form 1.
Mark the box or boxes naming the document(s) you are mailing to your spouse. If you are mailing a form not listed, write the name of the form in the “other” space provided.
Box 5: Print your spouse's name and address.
Box 6: Write the date.
Box 7: Sign and Print your name.
File the completed form with the Prothonotary / Clerk.
CERTIFICATE OF SERVICE
The undersigned hereby certifies that on this date, a true and correct copy of the following have been served: (check any of the following that apply)
Notice of Intention to File a Praecipe to Transmit the Record of Section 3301(d), OR Section 3301(c)(2)
- Affidavit of Non-Military Service
- Notice of Intention to Request Entry of Section 3301(c)(1) Divorce Decree, and Counter-Affidavit Under 3301(c)(1)
- (Other)___
The undersigned hereby certifies that the above documents were served by first class mail to the following: 5
IN THE COURT OF COMMON PLEAS OF _____ COUNTY, PENNSYLVANIA CIVIL ACTION
PLAINTIFF :
DEFENDANT
VS. :
Case No. _____
CERTIFICATE OF SERVICE
The undersigned hereby certifies that on this date, a true and correct copy of the following have been served: (check any of the following that apply)
Notice of Intention to File a Praecipe to Transmit the Record of Section 3301(d), OR Section 3301(c)(2)
Affidavit of Non-Military Service
Notice of Intention to Request Entry of Section 3301(c)(1) Divorce Decree, and Counter-Affidavit Under 3301(c)(1)
(Other)___
The undersigned hereby certifies that the above documents were served by first class mail to the following:
(spouse's name)
(spouse's address)
(spouse's telephone)
Date:_____
(Signature)
Print Name
Divorce Form 11 Certificate of Service AOPC 5.1.14.
IN THE COURT OF COMMON PLEAS FOR ADAMS COUNTY, PENNSYLVANIA CIVIL ACTION - LAW
| Name | PLAINTIFF |
|---|---|
| vs. | |
| Name | DEFENDANT 1 |
| and (if applicable) | |
| Name | DEFENDANT 2 |
CASE NO. _____
CERTIFICATE OF COMPLIANCE
I certify that this filing complies with the provisions of the Case Record Public Access Policy of the Unified Judicial System of Pennsylvania: Case Records of the Appellate and Trial Courts that require filing confidential information and documents differently than non-confidential information and documents.
Signature: _____
Petitioner Date: _____
Print Name: _____
Date: