Civil Cover Sheet Page 11
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22Instructions for completing
Petition to Proceed
In Forma Pauperis
1. All blanks and all questions MUST be filled in or answered.
Dollar amounts MUST be clearly stated where requested.
2. A copy of your latest Pennsylvania tax or federal tax return
should be attached.
3. Service of a copy of this petition MUST be made on the
opposing party or opposing party’s attorney.
4. Please attach a self-addressed, stamped envelope for
yourself and an addressed, stamped envelope for each
opposing party or opposing party’s attorney.
5. Petitioner is required to have the enclosed Affidavit notarized
by a licensed Notary Public.
6. Your petition may be dismissed or denied for failure to
properly complete all information.
Definition of Terms:
Affidavit: A voluntary declaration of facts written down and sworn to by the declarant before an
officer authorized to administer oaths.
Defendant: A person who is sued in a civil or criminal proceeding.
In Forma Pauperis: [Latin “in the manner of a pauper”] To proceed in the manner of an
indigent who is permitted to disregard filing fees and court costs.
Petitioner: A party who presents a petition to a court or other official body.
Plaintiff: The party who brings a civil suit in a court of law against another person or entity.
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