Petition To Proceed In Forma Pauperis Instruction Sheet Page 10
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104.
I understand that I have a continuing obligation to inform the Court of improvement in
my financial circumstances which would permit me to pay the costs incurred herein.
5.
I verify that the statements in this affidavit are true and correct. I understand that false
statements herein are made subject to the penalties of 18 Pa. C.S.A. § 4904, relating to
unsworn falsification to authorities.
_________________
Date
Petitioner
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