Entry Of Appearance As A Self-Represented Party Form - Pennsylvania Court Of Common Pleas Beaver County
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1______________________________________________
IN THE COURT OF COMMON PLEAS
PLAINTIFF
BEAVER COUNTY, PENNSYLVANIA
vs.
NO. _____________________________
______________________________________________
DEFENDANT
ENTRY OF APPEARANCE AS A SELF-REPRESENTED PARTY
1.
I am the
Plaintiff
Defendant in the above-captioned (MARK ONE)
custody,
divorce,
support,
protection from abuse,
paternity case.
2.
This (CIRCLE ONE) is/is not a new case and I am representing myself in this case and have decided not to
hire an attorney to represent me.
OR (check only one box)
This is NOT a new case and ____________________________________________________ previously
(Name of Attorney)
represented me in this case. I have decided not to be represented by that attorney and direct the Prothonotary to
remove that attorney as my counsel of record in this case.
I have provided a copy of this form to that attorney listed above at the following address:
_____________________________________________________________________________________________
OR (check only one box)
I am entering my appearance as a self-represented party (sign) ___________________________________
I am withdrawing my appearance as attorney in this case (attorney signature) ________________________
3.
My address for the purpose of receiving all future pleadings and other legal notices is: ________________________
____________________________________________. I understand that this address will be the only address to
which notices and pleadings in this case will be sent, and that I am responsible to regularly check my mail at this
address to ensure that I do not miss important deadlines or proceedings.
This is my home address.
This is not my home address.
My telephone number where I can be reached during normal business hours (8:30 a.m. – 4:30 p.m. Monday – Friday)
4.
is ______________________________________.
My email address is _________________________
My telephone number is confidential pursuant to a Protection From Abuse Order.
5.
I UNDERSTAND I MUST FILE A NEW FORM EVERY TIME MY ADDRESS OR TELEPHONE NUMBER
CHANGES.
6.
I have provided a copy of this form to all other attorneys or other self-represented parties at the
following addresses as listed below: (Use reverse side if you need more space)
Name______________________________ Address__________________________________________
Name______________________________ Address__________________________________________
7.
I fully understand that by deciding to represent myself, the Court will hold me to the same standards of knowledge
regarding the statutory law, evidence law, Local and State Rules of Procedure and applicable case law as a
Pennsylvania licensed attorney, and that I must be fully prepared to meet those responsibilities.
I verify that the statements made in this Entry of Appearance as a Self-Represented Party are true and
correct. I understand that if I make false statements herein, that I am subject to the criminal penalties of 18
Pa.C.S. § 4904 relating to unsworn falsification to authorities which could result in a fine and/or prison term.
_____________________
_________________________________________________________
Date
Signature (Your Signature)
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