Petition To Settle Wrongful Death And Survival Actions Page 10
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105-19-16
FIRST JUDICIAL DISTRICT OF PENNSYLVANIA
COURT OF COMMON PLEAS OF PHILADELPHIA COUNTY
Trial Division - Civil
:
TERM, 20
:
v.
:
:
:
NO:
AFFIDAVIT
I,
, Esquire, hereby state and affirm that I have complied with
the Order issued on ___________________ by the Honorable ________________ as follows:
Copies of bank accounts are attached hereto.
I verify that the statements in this Affidavit are made subject to the penalties of 18 Pa. C.S.
4904 relating to unsworn falsification to authorities.
DATE: ___________________
__________________________
, Esquire
Attorney for Petitioner
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