Entry Of Appearance As A Self-Represented Party - Court Of Common Pleas Of Warren County Pennsylvania

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IN THE COURT OF COMMON PLEAS OF WARREN COUNTY PENNSYLVANIA
_____________________________,
PLAINTIFF
NO. A.D. _________ OF _________
VS.
In Custody
_____________________________,
DEFENDANT
ENTRY OF APPEARANCE AS A SELF-REPRESENTED PARTY
1. I, ____________________________, am the ☐ Plaintiff ☐ Defendant in the above-captioned case.
I am representing myself and have decided not to hire an attorney to represent me.
☐ This is a new case (if yes go to Paragraph 3).
2.
(check only one box)
☐ This is not a new case and I have not previously been represented by an attorney.
OR
☐ This is not a new case and ______________________________________ previously represented
(Name of Attorney)
me. My attorney acknowledges his/her withdrawal as my attorney in this case.
(Attorney signature) ____________________________________________________, Esq.
OR
☐ This is not a new case and ______________________________________ previously represented
(Name of Attorney)
me. I have decided not to be represented by that attorney and request that he/she be removed
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:
_____________________________________________________________________________
3. My address for the purpose of receiving all future pleadings and other legal notices is:
Mailing Address: _____________________________________________________________
City: _________________________________ State: _________ Zip Code: _____________
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 to ensure that I do not miss important
deadlines or proceedings.
☐ This is my home address.
☐ This is not my home address.
4. The telephone number where I can be reached during normal business hours (8:00 a.m. – 4:30 p.m.
Monday – Friday) is ______________________________________.
☐ My telephone number is confidential pursuant to a Protection From Abuse Order (leave blank).
5. I UNDERSTAND I MUST FILE AN UPDATED FORM WITH THE COURT EACH TIME MY ADDRESS OR
TELEPHONE NUMBER CHANGES.
6. I have provided a copy of this Entry of Appearance to all other self-represented parties and attorneys
of record at the following addresses as listed below:
Name_______________________ Address__________________________________________
7. I understand that a self-represented party is subject to the same laws and rules as an individual
represented by an attorney.
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

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