IN THE COURT OF COMMON PLEAS FOR ADAMS COUNTY, PENNSYLVANIA CIVIL ACTION - LAW

Name1(CICForm)
NamePLAINTIFF
vs.
NameDEFENDANT 1
and (if applicable)
NameDEFENDANT 2
Name2(CICForm)
Name3(CICForm)
Case(CICForm)

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: _____

Name4(CICForm)

Date:

Date(CICForm)