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Certificate of Service
Form 11
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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.
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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:
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IN THE COURT OF COMMON PLEAS OF _____ COUNTY, PENNSYLVANIA
CIVIL ACTION
Print the name of the county in which you filed exactly as you wrote it on Form 1.
PLAINTIFF :
Print the name of the Plaintiff exactly as it appears on Form 1.
Print the name of the Defendant exactly as it appears on Form 1.
DEFENDANT
VS. :
Case No. _____
Print the docket number that the Prothonotary's Office wrote on Form 1 at the time of filing.
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)
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.
Affidavit of Non-Military Service
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.
Notice of Intention to Request Entry of Section 3301(c)(1) Divorce Decree, and Counter-Affidavit Under 3301(c)(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.
(Other)___
If you are mailing a form not listed, above, write the name of the form on this line.
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.
The undersigned hereby certifies that the above documents were served by first class mail to the following:
Print your spouse's name.
(spouse's name)
Print your spouse's address
(spouse's address)
Print your spouse's city, state, and zip code.
Print your spouse's telephone number. format is XXX-XXX-XXXX
(spouse's telephone)
Date:_____
Write the date. Format is XX/XX/XXXX
Sign your name.
(Signature)
Print your name.
Print Name
Divorce Form 11
Certificate of Service
AOPC 5.1.14.
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IN THE COURT OF COMMON PLEAS FOR ADAMS COUNTY, PENNSYLVANIA
CIVIL ACTION - LAW
Name1(CICForm)
| Name | PLAINTIFF |
|---|---|
| vs. | |
| Name | DEFENDANT 1 |
| and (if applicable) | |
| Name | DEFENDANT 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)