No. ___ -S-___
Appellant
V.
The undersigned hereby certifies that on _____, 20___, I caused to be mailed by United States certified mail, return receipt requested, a copy of the Order of Court dated _____, 20___, scheduling a hearing in the above matter, to the Pennsylvania Department of Transportation, Office of Chief Counsel, Third Floor, Riverfront Office Center, Harrisburg, Pennsylvania 17104-2516. The return receipt signed by a representative of the Pennsylvania Department of Transportation is attached hereto.
___
Date
Appellant