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______________________________________________

IN THE COURT OF COMMON PLEAS

PLAINTIFF

LYCOMING COUNTY, PENNSYLVANIA

vs.

NO. _____________________________

______________________________________________

DEFENDANT

ENTRY OF APPEARANCE AS A SELF-REPRESENTED PARTY

I am the

Plaintiff

Defendant in the above-captioned (CIRCLE) custody, divorce, support, protection from

abuse, relocation, paternity case.

I need to update my address and/or telephone number on file with the Prothonotary.

OR (check only one box)

This is a new case and I am representing myself in this case and have decided not to hire an

attorney to represent me.

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 counsel of record in this case.

I have provided a copy of this form to the attorney listed above at the following address:

__________________________________________________________________________

My next scheduled court date is: ____________________________________

My address for the purpose of receiving pleadings and other legal notices:

_____________________________________________________________

My home telephone number is _____________

My cell telephone number is ________________

____

I UNDERSTAND THAT I MUST FILE THIS FORM EVERY TIME MY ADDRESS, TELEPHONE

initial

NUMBER OR CELL PHONE NUMBER CHANGE.

____

I have provided a copy of this form to all other attorneys or other self-represented parties at the

initial

following addresses as listed below: (use reverse side if you need more space)

Name__________________________

Address________________________________________

Name__________________________

Address________________________________________

____

I understand that by deciding to represent myself, the Court will hold me to the same standards

initial

as a licensed attorney and that I must follow the Pennsylvania Rules of Civil Procedure and the

Lycoming County Local Rules of Court. My Entry of Appearance will be effective unless and until an

appearance of new counsel is entered

I verify that the statements made in the Entry of Appearance as a Self-Represented Party are true and

correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. § 4904

relating to unsworn falsification to authorities.

_____________________

___________________________________

Date

Signature (Your Signature)

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

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