[ { "page": 1, "items": [ { "page": 1, "type": "TITLE", "location": { "l": 163.44, "t": 453.36, "r": 447.36, "b": 422.64 }, "text": "Certificate of Service", "reading_order": 0, "level": 1 }, { "page": 1, "type": "TEXT", "location": { "l": 270.24, "t": 390.48, "r": 351.84, "b": 366.96 }, "text": "Form 11", "reading_order": 1 } ] }, { "page": 2, "items": [ { "page": 2, "type": "TITLE", "location": { "l": 216.72, "t": 664.56, "r": 400.56, "b": 650.16 }, "text": "Form 11 – Certificate of Service", "reading_order": 0, "level": 2 }, { "page": 2, "type": "TEXT", "location": { "l": 87.12, "t": 636.72, "r": 518.64, "b": 594.96 }, "text": "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.", "reading_order": 1 }, { "page": 2, "type": "TEXT", "location": { "l": 87.12, "t": 581.76, "r": 518.88, "b": 553.92 }, "text": "Box 1: Print the name of the county in which you filed exactly as you wrote it on Form 1.", "reading_order": 2 }, { "page": 2, "type": "TEXT", "location": { "l": 86.88, "t": 540.72, "r": 463.68, "b": 525.6 }, "text": "Box 2: Print the name of the Plaintiff exactly as it appears on Form 1.", "reading_order": 3 }, { "page": 2, "type": "TEXT", "location": { "l": 87.36, "t": 513.12, "r": 512.64, "b": 484.08 }, "text": "Box 3: Print the docket number that the Prothonotary's Office wrote on Form 1 at the time of filing.", "reading_order": 4 }, { "page": 2, "type": "TEXT", "location": { "l": 87.12, "t": 471.6, "r": 480, "b": 456.48 }, "text": "Box 4: Print the name of the Defendant exactly as it appears on Form 1.", "reading_order": 5 }, { "page": 2, "type": "TEXT", "location": { "l": 87.12, "t": 443.76, "r": 512.88, "b": 394.32 }, "text": "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.", "reading_order": 6 }, { "page": 2, "type": "TEXT", "location": { "l": 87.12, "t": 381.84, "r": 341.76, "b": 366.72 }, "text": "Box 5: Print your spouse's name and address.", "reading_order": 7 }, { "page": 2, "type": "TEXT", "location": { "l": 87.36, "t": 354.48, "r": 212.16, "b": 339.84 }, "text": "Box 6: Write the date.", "reading_order": 8 }, { "page": 2, "type": "TEXT", "location": { "l": 87.36, "t": 326.88, "r": 272.64, "b": 311.52 }, "text": "Box 7: Sign and Print your name.", "reading_order": 9 }, { "page": 2, "type": "TEXT", "location": { "l": 86.88, "t": 278.16, "r": 448.32, "b": 260.64 }, "text": "File the completed form with the Prothonotary / Clerk.", "reading_order": 10 } ] }, { "page": 3, "items": [ { "page": 3, "type": "FIGURE", "location": { "l": 67.92, "t": 755.04, "r": 499.68, "b": 566.16 }, "text": "", "reading_order": 0 }, { "page": 3, "type": "TEXT", "location": { "l": 87.6, "t": 657.12, "r": 147.12, "b": 643.2 }, "text": "PLAINTIFF", "reading_order": 1 }, { "page": 3, "type": "TEXT", "location": { "l": 339.84, "t": 631.68, "r": 390.24, "b": 618 }, "text": "Case No.", "reading_order": 2 }, { "page": 3, "type": "TEXT", "location": { "l": 87.6, "t": 581.04, "r": 160.32, "b": 567.6 }, "text": "DEFENDANT", "reading_order": 3 }, { "page": 3, "type": "TITLE", "location": { "l": 231.12, "t": 548.16, "r": 378.72, "b": 535.68 }, "text": "CERTIFICATE OF SERVICE", "reading_order": 4, "level": 2 }, { "page": 3, "type": "TEXT", "location": { "l": 86.88, "t": 535.44, "r": 518.88, "b": 503.28 }, "text": "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)", "reading_order": 5 }, { "page": 3, "type": "TEXT", "location": { "l": 158.88, "t": 493.92, "r": 523.2, "b": 462.24 }, "text": "Notice of Intention to File a Praecipe to Transmit the Record of Section 3301(d), OR Section 3301(c)(2)", "reading_order": 6 }, { "page": 3, "type": "LIST_ITEM", "location": { "l": 149.52, "t": 454.32, "r": 332.4, "b": 436.8 }, "text": "Affidavit of Non-Military Service", "marker": "○", "list_id": "L1", "level": 0, "reading_order": 7 }, { "page": 3, "type": "LIST_ITEM", "location": { "l": 149.28, "t": 427.68, "r": 498.72, "b": 395.04 }, "text": "Notice of Intention to Request Entry of Section 3301(c)(1) Divorce Decree, and Counter-Affidavit Under 3301(c)(1)", "marker": "○", "list_id": "L1", "level": 0, "reading_order": 8 }, { "page": 3, "type": "LIST_ITEM", "location": { "l": 149.52, "t": 386.64, "r": 523.44, "b": 368.4 }, "text": "(Other)___", "marker": "○", "list_id": "L1", "level": 0, "reading_order": 9 }, { "page": 3, "type": "TEXT", "location": { "l": 86.16, "t": 321.84, "r": 517.44, "b": 280.56 }, "text": "The undersigned hereby certifies that the above documents were served by first class mail to the following:\n\n5", "reading_order": 10 }, { "page": 3, "type": "FIGURE", "location": { "l": 86.88, "t": 300.24, "r": 516.48, "b": 72.24 }, "text": "", "reading_order": 11 }, { "page": 3, "type": "TEXT", "location": { "l": 263.04, "t": 249.84, "r": 347.76, "b": 235.92 }, "text": "(spouse's name)", "reading_order": 12 }, { "page": 3, "type": "TEXT", "location": { "l": 257.52, "t": 225.12, "r": 354, "b": 210.72 }, "text": "(spouse's address)", "reading_order": 13 }, { "page": 3, "type": "TEXT", "location": { "l": 139.92, "t": 165.12, "r": 184.08, "b": 140.88 }, "text": "6", "reading_order": 14 }, { "page": 3, "type": "TEXT", "location": { "l": 88.32, "t": 139.44, "r": 239.52, "b": 121.2 }, "text": "Date:___", "reading_order": 15 }, { "page": 3, "type": "TEXT", "location": { "l": 305.28, "t": 123.84, "r": 361.92, "b": 109.2 }, "text": "(Signature)", "reading_order": 16 }, { "page": 3, "type": "TEXT", "location": { "l": 303.84, "t": 85.68, "r": 362.88, "b": 71.76 }, "text": "Print Name", "reading_order": 17 } ] }, { "page": 4, "items": [ { "page": 4, "type": "TITLE", "location": { "l": 88.08, "t": 721.68, "r": 566.88, "b": 690.48 }, "text": "IN THE COURT OF COMMON PLEAS OF _____ COUNTY, PENNSYLVANIA\nCIVIL ACTION", "reading_order": 0, "level": 1 }, { "page": 4, "type": "FORM_FIELD", "location": { "l": 301.706, "t": 722.465, "r": 423.918, "b": 708.174 }, "text": "Print the name of the county in which you filed exactly as you wrote it on Form 1.", "field_kind": "text", "label": "Print the name of the county in which you filed exactly as you wrote it on Form 1.", "pdf_field_name": "County", "pdf_field_type": "Text", "reading_order": 1 }, { "page": 4, "type": "TEXT", "location": { "l": 86.64, "t": 668.88, "r": 313.44, "b": 646.32 }, "text": "PLAINTIFF :", "reading_order": 2 }, { "page": 4, "type": "FORM_FIELD", "location": { "l": 90.2686, "t": 672.783, "r": 280.201, "b": 657.372 }, "text": "Print the name of the Plaintiff exactly as it appears on Form 1.", "field_kind": "text", "label": "Print the name of the Plaintiff exactly as it appears on Form 1.", "pdf_field_name": "Plaintiff", "pdf_field_type": "Text", "reading_order": 3 }, { "page": 4, "type": "FIGURE", "location": { "l": 86.64, "t": 623.76, "r": 313.44, "b": 601.2 }, "text": "", "reading_order": 4 }, { "page": 4, "type": "FORM_FIELD", "location": { "l": 89.8973, "t": 596.742, "r": 279.831, "b": 581.825 }, "text": "Print the name of the Defendant exactly as it appears on Form 1.", "field_kind": "text", "label": "Print the name of the Defendant exactly as it appears on Form 1.", "pdf_field_name": "Defendant", "pdf_field_type": "Text", "reading_order": 5 }, { "page": 4, "type": "TITLE", "location": { "l": 87.84, "t": 580.8, "r": 160.08, "b": 567.84 }, "text": "DEFENDANT", "reading_order": 6, "level": 2 }, { "page": 4, "type": "TEXT", "location": { "l": 86.64, "t": 646.32, "r": 313.44, "b": 623.76 }, "text": "VS. :", "reading_order": 7 }, { "page": 4, "type": "TEXT", "location": { "l": 339.6, "t": 631.92, "r": 479.76, "b": 617.76 }, "text": "Case No. _____", "reading_order": 8 }, { "page": 4, "type": "FORM_FIELD", "location": { "l": 392.053, "t": 633.581, "r": 477.734, "b": 620.037 }, "text": "Print the docket number that the Prothonotary's Office wrote on Form 1 at the time of filing.", "field_kind": "text", "label": "Print the docket number that the Prothonotary's Office wrote on Form 1 at the time of filing.", "pdf_field_name": "Case Number", "pdf_field_type": "Text", "reading_order": 9 }, { "page": 4, "type": "TITLE", "location": { "l": 231.6, "t": 556.32, "r": 378.48, "b": 543.6 }, "text": "CERTIFICATE OF SERVICE", "reading_order": 10, "level": 2 }, { "page": 4, "type": "TEXT", "location": { "l": 87.36, "t": 543.36, "r": 518.64, "b": 509.04 }, "text": "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)", "reading_order": 11 }, { "page": 4, "type": "TEXT", "location": { "l": 152.16, "t": 493.92, "r": 501.36, "b": 465.6 }, "text": "Notice of Intention to File a Praecipe to Transmit the Record of Section 3301(d), OR Section 3301(c)(2)", "reading_order": 12 }, { "page": 4, "type": "FORM_FIELD", "location": { "l": 136.892, "t": 492.904, "r": 150.417, "b": 480.243 }, "text": "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.", "field_kind": "checkbox", "label": "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.", "pdf_field_name": "Check Box1", "pdf_field_type": "CheckBox", "reading_order": 13 }, { "page": 4, "type": "TEXT", "location": { "l": 151.92, "t": 441.6, "r": 310.32, "b": 426.96 }, "text": "Affidavit of Non-Military Service", "reading_order": 14 }, { "page": 4, "type": "FORM_FIELD", "location": { "l": 136.843, "t": 441, "r": 150.367, "b": 428.967 }, "text": "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.", "field_kind": "checkbox", "label": "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.", "pdf_field_name": "Check Box2", "pdf_field_type": "CheckBox", "reading_order": 15 }, { "page": 4, "type": "TEXT", "location": { "l": 152.16, "t": 402.96, "r": 476.4, "b": 374.64 }, "text": "Notice of Intention to Request Entry of Section 3301(c)(1) Divorce Decree, and Counter-Affidavit Under 3301(c)(1)", "reading_order": 16 }, { "page": 4, "type": "FORM_FIELD", "location": { "l": 136.062, "t": 400, "r": 149.587, "b": 387.967 }, "text": "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.", "field_kind": "checkbox", "label": "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.", "pdf_field_name": "Check Box3", "pdf_field_type": "CheckBox", "reading_order": 17 }, { "page": 4, "type": "TEXT", "location": { "l": 151.92, "t": 352.08, "r": 503.28, "b": 337.44 }, "text": "(Other)___", "reading_order": 18 }, { "page": 4, "type": "FORM_FIELD", "location": { "l": 189, "t": 347, "r": 499.607, "b": 333 }, "text": "If you are mailing a form not listed, above, write the name of the form on this line.", "field_kind": "text", "label": "If you are mailing a form not listed, above, write the name of the form on this line.", "pdf_field_name": "OtherNoticeServed", "pdf_field_type": "Text", "reading_order": 19 }, { "page": 4, "type": "FORM_FIELD", "location": { "l": 137.104, "t": 351, "r": 150.628, "b": 338.967 }, "text": "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.", "field_kind": "checkbox", "label": "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.", "pdf_field_name": "Check Box5", "pdf_field_type": "CheckBox", "reading_order": 20 }, { "page": 4, "type": "TEXT", "location": { "l": 86.64, "t": 307.44, "r": 516.72, "b": 273.12 }, "text": "The undersigned hereby certifies that the above documents were served by first class mail to the following:", "reading_order": 21 }, { "page": 4, "type": "FORM_FIELD", "location": { "l": 220.784, "t": 263.535, "r": 392.275, "b": 248.987 }, "text": "Print your spouse's name.", "field_kind": "text", "label": "Print your spouse's name.", "pdf_field_name": "SpouseName", "pdf_field_type": "Text", "reading_order": 22 }, { "page": 4, "type": "TEXT", "location": { "l": 263.04, "t": 250.32, "r": 348.48, "b": 235.92 }, "text": "(spouse's name)", "reading_order": 23 }, { "page": 4, "type": "FORM_FIELD", "location": { "l": 220.784, "t": 237.802, "r": 391.903, "b": 223.254 }, "text": "Print your spouse's address", "field_kind": "text", "label": "Print your spouse's address", "pdf_field_name": "SpouseAddress1", "pdf_field_type": "Text", "reading_order": 24 }, { "page": 4, "type": "TEXT", "location": { "l": 221.76, "t": 225.12, "r": 392.64, "b": 197.76 }, "text": "(spouse's address)", "reading_order": 25 }, { "page": 4, "type": "FORM_FIELD", "location": { "l": 220.064, "t": 212.816, "r": 391.927, "b": 198.268 }, "text": "Print your spouse's city, state, and zip code.", "field_kind": "text", "label": "Print your spouse's city, state, and zip code.", "pdf_field_name": "SpouseAddress2", "pdf_field_type": "Text", "reading_order": 26 }, { "page": 4, "type": "FORM_FIELD", "location": { "l": 220.401, "t": 186.746, "r": 391.52, "b": 172.198 }, "text": "Print your spouse's telephone number. format is XXX-XXX-XXXX", "field_kind": "text", "label": "Print your spouse's telephone number. format is XXX-XXX-XXXX", "pdf_field_name": "SpousePhone", "pdf_field_type": "Text", "reading_order": 27 }, { "page": 4, "type": "TEXT", "location": { "l": 259.92, "t": 173.28, "r": 357.12, "b": 159.36 }, "text": "(spouse's telephone)", "reading_order": 28 }, { "page": 4, "type": "TEXT", "location": { "l": 87.84, "t": 136.08, "r": 240.72, "b": 121.92 }, "text": "Date:_____", "reading_order": 29 }, { "page": 4, "type": "FORM_FIELD", "location": { "l": 117.485, "t": 136.734, "r": 238.991, "b": 122.186 }, "text": "Write the date. Format is XX/XX/XXXX", "field_kind": "text", "label": "Write the date. Format is XX/XX/XXXX", "pdf_field_name": "DateSigned", "pdf_field_type": "Text", "reading_order": 30 }, { "page": 4, "type": "FORM_FIELD", "location": { "l": 306.196, "t": 146.803, "r": 513.49, "b": 124.848 }, "text": "Sign your name.", "field_kind": "signature", "label": "Sign your name.", "pdf_field_name": "PlaintiffSignature", "pdf_field_type": "Signature", "reading_order": 31 }, { "page": 4, "type": "TEXT", "location": { "l": 304.32, "t": 124.56, "r": 362.4, "b": 109.2 }, "text": "(Signature)", "reading_order": 32 }, { "page": 4, "type": "FORM_FIELD", "location": { "l": 306.192, "t": 101.676, "r": 513.863, "b": 87.1283 }, "text": "Print your name.", "field_kind": "text", "label": "Print your name.", "pdf_field_name": "PlaintiffName", "pdf_field_type": "Text", "reading_order": 33 }, { "page": 4, "type": "TEXT", "location": { "l": 304.32, "t": 85.92, "r": 362.88, "b": 71.52 }, "text": "Print Name", "reading_order": 34 }, { "page": 4, "type": "TEXT", "location": { "l": 87.36, "t": 43.44, "r": 166.32, "b": 15.36 }, "text": "Divorce Form 11\nCertificate of Service\nAOPC 5.1.14.", "reading_order": 35 } ] }, { "page": 5, "items": [ { "page": 5, "type": "TITLE", "location": { "l": 82.32, "t": 720.48, "r": 528.72, "b": 691.2 }, "text": "IN THE COURT OF COMMON PLEAS FOR ADAMS COUNTY, PENNSYLVANIA\nCIVIL ACTION - LAW", "reading_order": 0, "level": 1 }, { "page": 5, "type": "FORM_FIELD", "location": { "l": 72, "t": 692.64, "r": 269.986, "b": 666.12 }, "text": "Name1(CICForm)", "field_kind": "text", "label": "Name1(CICForm)", "pdf_field_name": "Name1(CICForm)", "pdf_field_type": "Text", "reading_order": 1 }, { "page": 5, "type": "TABLE", "location": { "l": 66.96, "t": 670.08, "r": 282.24, "b": 511.2 }, "text": "
NamePLAINTIFF
vs.
NameDEFENDANT 1
and (if applicable)
NameDEFENDANT 2
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282.24, 606.528 ], "cells": [ { "location": [ 66.96, 574.752, 174.6, 606.528 ], "text": "Name", "html_text": "Name", "links": [], "cell_header_index": 0, "rowspan": 1, "colspan": 1, "column_header": false, "row_header": true, "placeholder": false, "ref": "#/tables/0" }, { "location": [ 174.6, 574.752, 282.24, 606.528 ], "text": "DEFENDANT 1", "html_text": "DEFENDANT 1", "links": [], "cell_header_index": 1, "rowspan": 1, "colspan": 1, "column_header": false, "row_header": false, "placeholder": false, "ref": "#/tables/0" } ], "ref": "#/tables/0" }, { "row_index": 3, "location": [ 66.96, 542.976, 282.24, 574.752 ], "cells": [ { "location": [ 66.96, 542.976, 282.24, 574.752 ], "text": "and (if applicable)", "html_text": "and (if applicable)", "links": [], "cell_header_index": 0, "rowspan": 1, "colspan": 2, "column_header": false, "row_header": false, "placeholder": false, "ref": "#/tables/0" } ], "ref": "#/tables/0" }, { "row_index": 4, "location": [ 66.96, 511.2, 282.24, 542.976 ], "cells": [ { "location": [ 66.96, 511.2, 174.6, 542.976 ], "text": "Name", "html_text": "Name", "links": [], "cell_header_index": 0, "rowspan": 1, "colspan": 1, "column_header": false, "row_header": true, "placeholder": false, "ref": "#/tables/0" }, { "location": [ 174.6, 511.2, 282.24, 542.976 ], "text": "DEFENDANT 2", "html_text": "DEFENDANT 2", "links": [], "cell_header_index": 1, "rowspan": 1, "colspan": 1, "column_header": false, "row_header": false, "placeholder": false, "ref": "#/tables/0" } ], "ref": "#/tables/0" } ], "n_rows": 5, "n_cols": 2, "ref": "#/tables/0", "reading_order": 2 }, { "page": 5, "type": "FORM_FIELD", "location": { "l": 72, "t": 623.64, "r": 269.986, "b": 597.12 }, "text": "Name2(CICForm)", "field_kind": "text", "label": "Name2(CICForm)", "pdf_field_name": "Name2(CICForm)", "pdf_field_type": "Text", "reading_order": 3 }, { "page": 5, "type": "FORM_FIELD", "location": { "l": 72, "t": 554.64, "r": 269.986, "b": 528.12 }, "text": "Name3(CICForm)", "field_kind": "text", "label": "Name3(CICForm)", "pdf_field_name": "Name3(CICForm)", "pdf_field_type": "Text", "reading_order": 4 }, { "page": 5, "type": "FORM_FIELD", "location": { "l": 383.04, "t": 651.24, "r": 490.92, "b": 624.72 }, "text": "Case(CICForm)", "field_kind": "text", "label": "Case(CICForm)", "pdf_field_name": "Case(CICForm)", "pdf_field_type": "Text", "reading_order": 5 }, { "page": 5, "type": "TEXT", "location": { "l": 321.84, "t": 637.2, "r": 492.96, "b": 621.6 }, "text": "CASE NO. _____", "reading_order": 6 }, { "page": 5, "type": "TITLE", "location": { "l": 208.8, "t": 471.36, "r": 402.48, "b": 457.2 }, "text": "CERTIFICATE OF COMPLIANCE", "reading_order": 7, "level": 2 }, { "page": 5, "type": "TEXT", "location": { "l": 68.64, "t": 443.52, "r": 532.8, "b": 387.12 }, "text": "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.", "reading_order": 8 }, { "page": 5, "type": "TEXT", "location": { "l": 69.6, "t": 346.8, "r": 306.48, "b": 331.92 }, "text": "Signature: _____", "reading_order": 9 }, { "page": 5, "type": "TEXT", "location": { "l": 68.88, "t": 332.16, "r": 306, "b": 318.24 }, "text": "Petitioner\nDate: _____", "reading_order": 10 }, { "page": 5, "type": "TEXT", "location": { "l": 69.84, "t": 305.28, "r": 309.36, "b": 290.16 }, "text": "Print Name: _____", "reading_order": 11 }, { "page": 5, "type": "FORM_FIELD", "location": { "l": 133.32, "t": 320.16, "r": 307.32, "b": 293.64 }, "text": "Name4(CICForm)", "field_kind": "text", "label": "Name4(CICForm)", "pdf_field_name": "Name4(CICForm)", "pdf_field_type": "Text", "reading_order": 12 }, { "page": 5, "type": "TEXT", "location": { "l": 357.6, "t": 346.8, "r": 510.48, "b": 331.92 }, "text": "Date:", "reading_order": 13 }, { "page": 5, "type": "FORM_FIELD", "location": { "l": 388.92, "t": 361.56, "r": 508.92, "b": 335.04 }, "text": "Date(CICForm)", "field_kind": "text", "label": "Date(CICForm)", "pdf_field_name": "Date(CICForm)", "pdf_field_type": "Text", "reading_order": 14 } ] } ]