Petition To Proceed In Forma Pauperis (Page 4 of 11) in pdf

Petition To Proceed In Forma Pauperis Page 4

First Judicial District of Pennsylvania

Court of Common Pleas of Philadelphia County

Trial Division – Civil

Term, 20

(month)

(year)

Plaintiff(s)

VS.

NO.

Defendant(s)

In Forma Pauperis Order

AND NOW, this

day of

, 20

, it is hereby ORDERED AND

DECREED that:

1. Petitioner be permitted to proceed without paying the costs of this proceeding.

2. Petitioner be permitted to obtain service of the papers filed without cost.

3. Petitioner be permitted to proceed in forma pauperis as to any additional costs which accrue in the course of this

proceeding.

4. If there is a monetary recovery by judgment or settlement in favor of the party permitted to proceed in forma pauperis,

the exonerated fees and costs shall be taxed as costs and paid to the Office of Judicial Records by the party paying the

monetary recovery.

5. Petitioner has a continuing obligation to inform the Court of any improvement in party’s financial circumstances that

will enable the party to pay costs.

6. Filing party must obtain attested copies of the original pleading for service. If more than thirty (30) days has expired,

the pleading must be reinstated first.

BY THE COURT:

Petition To Proceed In Forma Pauperis Page 4