Form 10 - Summary Process Summons And Complaint Page 2

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Form 10 ( continued)
To the Sheriffs of our several Counties, or their Deputies, or any Constable of any City or Town within said
Commonwealth, GREETINGS: We command you to summon the within named tenant/occupant to appear
as herein ordered.
WITNESS,
_____________________________________
First or Administrative Justice
_____________________________________
_____________________________________
Clerk-Magistrate
Entry Date
OFFICER’S RETURN
___________________________________, ss: City/Town ____________________ Date ____________________
By virtue of this Writ, I this day served the within-named tenant or occupant and summoned him/her as
herein directed, by giving it in hand to _____________________________________________________________
_______________________________________________________________________________ or by leaving it at
_______________________________________________________________________________________________
the last an usual place of abode. A copy of this summons was mailed first class to the tenant/occupant at that
address on _________________________________________________________________________________.
_____________________________________
Signature of Officer
_____________________________________
Printed Name of Officer
Fees:
Service ________________
Copy _________________
Notice to Landlord/Owner:
Travel _________________
Have the Officer complete and return above.
Use of Care ____________
Service must be made on the defendant no later
L&U Mailing __________
than the seventh day and not earlier than the
$ _________________
thirtieth day before the Monday entry day.
This form must be filed in court no later than
the close of business on the scheduled Monday
entry day. In appropriate cases, proper evidence
of notice to quit must be provided this court upon
the filing of this complaint. See Rule 2(d). Accord-
ing to Rule 2(c), the hearing date is the second
Thursday (or Friday or Monday in some courts)
after the entry day.

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