Fillable Civil Cover Sheet (Page 10 of 22) in pdf

Civil Cover Sheet Page 10

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MOTION TO PROCEED IN FORMA PAUPERIS

PHILADELPHIA COURT OF COMMON PLEAS

CONTROL NUMBER:

PETITION/MOTION COVER SHEET

FOR COURT USE ONLY

(RESPONDING PARTIES MUST INCLUDE THIS

ANSWER/RESPONSE DATE:

ASSIGNED TO JUDGE:

NUMBER ON ALL FILINGS)

Term,

Do not send Judge courtesy copy of Petition/Motion/Answer/Response.

Month

Year

Status may be obtained online at

No.

Name of Filing Party:

vs.

(Check one)

Plaintiff

Defendant

(Check one)

M o v a n t

Respondent

Has another petition/motion been decided in this case?

Yes

INDICATE NATURE OF DOCUMENT FILED:

Is another petition/motion pending?

Yes

Petition (Attach Rule to Show Cause)

M o t i o n

If the answer to either question is yes, you must identify the judge(s):

Answer

to Petition

Response to Motion

TYPE OF PETITION/MOTION (see list on reverse side)

PETITION/MOTION CODE

(see list on reverse side)

MOTION TO PROCEED IN FORMA PAUPERIS

MTIFP

ANSWER/RESPONSE FILED TO (Please insert the title of the corresponding petition/motion to which you are

responding):

I. CASE PROGRAM

II. PARTIES

(Name, address and telephone number of all counsel of record and

Is this case in the (answer all questions):

unrepresented parties.

Attach a stamped addressed

envelope for each

A. COMMERCE PROGRAM

attorney of record and unrepresented party.)

Name of Judicial Team Leader:

Applicable Petition/Motion Deadline:

Has deadline been previously extended by the Court?

Yes

B . DAY FORWARD/MAJOR JURY PROGRAM — Year

Name of Judicial Team Leader:

Applicable Petition/Motion Deadline:

Has deadline been previously extended by the Court?

Yes

C . NON JURY PROGRAM

Date Listed:

D. ARBITRATION PROGRAM

Arbitration Date:

E. ARBITRATION APPEAL PROGRAM

Date Listed:

F. OTHER PROGRAM:

Date Listed:

III. OTHER

By filing this document and signing below, the moving party certifies that this motion, petition, answer or response along with all documents filed,

will be served upon all counsel and unrepresented parties as required by rules of Court (see PA. R.C.P. 206.6, Note to 208.2(a), and 440). Furthermore,

moving party verifies that the answers made herein are true and correct and understands that sanctions may be imposed for inaccurate or incomplete

answers.

(Attorney Signature/Unrepresented Party)

(Date)

(Print Name)

(Attorney I.D. No.)

The Petition, Motion and Answer or Response, if any, will be forwarded to the Court after the Answer/Response Date.

No extension of the Answer/Response Date will be granted even if the parties so stipulate.

30-1061A (Rev. 7/05)