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NOTICE OF APPEAL
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"".I COMMONWEALTH OF PENNSYLVANIA
COURT OF COMMON PLEAS
FROM
JUDICIAL DISTRICT
DISTRICT JUSTICE JUDGMENT
C_MON PLEAS No. :J (J()CJ- J'I7'1 c:;t;;;t. "'!;;,?J
NOTICE OF APPEAL 3-/4-t)o
Notice is given that the appellant has filed in the above Caurt af Camman Pleas an appeal fram the judgment rendered by the District Justice on the
date and in the case mentioned below;
I MAG. DlSt NO. OIl NAME OF D!
DC, ~,3--o3
Sl~
ZIP CODE
)3
CV 19~ -Cb
LT 19
This bloc:k will be signed ONLY when this natation is required under Po. R.cP JP. No.
loo8B.
This No,lice af Appeal, when, received by the District Justice, will operate as a
SUPERSI:DEAS ta the judgment far possession in this case.
Signature af Prothonotary or Deputy
If appellant was CL"AIMANT (SeePa. R.GP.JP. No.
1001 (6) in action before District Justice, he MUST
FILE A COMPLAINT within twenty (20) days after
filing his NOTICE of APPEAL.
PRAECIPE TO ENTER RULE TO FILE COMPLAINT AND RULE TO FILE
(This sect.:m of form to. be used ONLY when appellant was DEFENDANT (see Pa, R.C,P,J.P. No., 1001 (7) in actlan befare District Justice.
IF NOT USED, detach from copy af natice af appeal to. be served upon appellee).
PRAECIPE: Ta Prothonotary
Enter rule upon
Name of appeJlee(s)
, appellee(s), ta file a complaint in this appeal
(Comman Pleas No.
) within twenty (20) days after service af rule or suffer entry of judgment af non pro~
Signature of appellant or his attorney or agent
RULE: T"
Name of appelfoe(s)
, appellee(s).
(1.1 Yau are natified that a rule is hereby entered upon you 10 file a complaint in this appeal within twenty (20) days after the dale of
service of this rule upon yau by personal service or by certified or registered mail
(2) If you da nat file a complaint w~hin this time, a JUDGMENT OF NON PROS WILL BE ENTERED AGAINST YOU.
(3:1 The date af service of this rule if service was by mail is the dale of mailing.
Date:
,19_.
~ of FloIhonotary or Deputy
N:JPC 312-84
COURT FILE TO BE FILED WITH PROTHONOTARY
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PROOF OF SERVICE OF NOTICE Of APPE.AL AND RULE TO FILE COMPLAINT
(This proof of service MUST BE FILED WITHIN TEN (101 DA YS AFTER filing the notice 01 appeal, Check applicable boxes)
COMMONWEALTH OF PENNSYLVANIA
COUNTY Of
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AFFIDAVIT: I hereby swear or affirm thaI I served
o a copy of the Notice of Appeal. Common PI"a,' No, , upon the District Justice designated therein on
(date of service) [] by personal service 0 by (certified) (registered) mail, sender's
receipt attached hereto, and upon the appellee, (name) , on
, '19_ 0 by personai service 0 by (certified) (registered) mall, sender's receiplattached hereto,
o and further that I served the Rule to File a Compiaint accompanying the above Notice of Appeal upon the appellee(s) to whom
the Rule was addressed on , 19~ 0 by personal service 0 by (certitied) (registered)
mai" sender's receipt attached hereto,
SWORN (AFFIRMED) AND SUBSCRIBED BEFORE ME
THIS
DAY OF
. 19_
Signature of official before whom affidavif was made
Tille of official
My commission, expires on
.19--
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COMMONWEALTH OF PENNSYLVANIA
COUNTY OF: CUMBERLAND
Mag, Dis!. No.:
09-3-03
DJ Name: Hon.
SUSAN K. DAY
Add",,, 229 MILL STREET, BOX 167
MT. HOLLY SPRINGS, PA
T".phO'" (717) 486 -7672
17065
HERMAN CHIROPRACTIC CENTER OF CARL.
1 VALLEY ST.
SUITE 106
CARLISLE, PA 17013
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Ti.t1SIS TO NOTIf'VYOUTt-:lAT:,.
Judgment: b --, ,
[iJ Judgment was entered for:
[iJ Judgment was entered against:
(Name)
(Name)
EN(!ll' IIR'I'mTR V
"
NOTICE OF JUDGMENTITRANSCRIPT
CIVIL CASE
PLAINTIFF: NAME and ADDRESS
IHERMAN CHIROPRACTIC CENTER OF CARL"")
1 VALLEY ST.
SUITE 106
~LISLE, PA 17013 ~
VS.
DEFENDANT: NAME and ADDRESS
IrmCK, ARTHOll, V
307 FORGE RD.
BOILING SPRINGS, PA 17007
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Docket No,: CV- 0000004 - 00
Date Filed: 1/07/00
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'FOR~nE'FENri'ANT "~'
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in the amount of $
H'RRMIIN CHTROPRIICTTCCEN'I'ER OF C
nn on:
o Defendants are jointiy and severally liable,
o Damages will be assessed on:
o This case dismissed without prejudice.
O Amount of Judgment Subject to
Attachment/Act 5 of 1996 $
o Levy is stayed for
days or 0 generally stayed.
o Objection to levy has been filed and hearing will be held:
(Date of Judgment)
?/??/nn
"
(Date & Time)
Amounfof Judgment $ .00
Judgm€)nf Costs $ . . .00
Interest on Judgment $ .00
Attorney Fees $ .00
Total $ .00
Post Judgment Credits $
Post Judgment Costs $ r
------'------
------------
Certified Judgment Total $
,"- .- -. .- , ,;......,L.
"Place: , ,
Date:
Time:
ANIY PARTY HAS THE RIGHT TO EAL WITHIN 30 DAYS AFTER THE ENTRY OF JUDGMENT BY FlUNG A NOTICE
OF APPEAL WITH THE PROf NOT RY/CLERK OF THE COU OF COMMON PLEAS, CIVIL DIVISION, YOU
MLlST INCLUDE A COpy OF HIS NO CE QF JUDG ENT/T N CRIPT FORM WITH YOUR NOTICE OF APPEAL.
. tJ.2-J:J- of) . Date '
My commission ex res first Monday of January,
Aope 315-99
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, Districl.Justice
t e p oceedings containing the judgment.
, District Justice
SEAL
~1 .III IP
COMMONWEALTH OF PENNSYLV~NIA
COURT OF COMMON PLEAS
NOTICE OF APPEAL
FROM
JUDICIAL DISTRICT
DISTRICT JUSTICE JUDGMENT
- COM_NPLEASN"c,,/L)OO- J'I79 cidlth,;
NOTICE OF APPEAL 3-/4.0CJ
Notice is given that the appellant has filed in the above Court af Cammon Pleas an appeal fram the judgment rendered by the District Justice on the
date and in the case mentioned below.
~ OF APf'ELLANT
I-U'.rro. (\'l\((
ADDRESS OF APPElLANT
\\bJ
DAa~a3~o
ClAIM NO
CV 19---.:1-cn
LT 19
This block will be ~gned ONLY wheillhii natation is required under Po. R.c.P JP. No.' .
10088. ., .
This NoNce of Appeal, when received by the District Justi~e., will-operale as a
SUPERS!:DEAS 10 the judgment for possessian in this case. .
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C . of~d~
SIGNATURE OF APPaLANT
MAG. DI51. NQ OR NAME OF OJ.
Dq ~ -03
STt1e
E
17013
')C!'~'(
~ C l(
If appellant was CL IMANT (see Pa. R.GP;JP. No.
1001 (6) In action be~ore District Justice, he MUST
FILE A COMPLAINT within twenty (20) days after
. filing his NOTICE of APPEAL.
LE TO FILE COMPLAINT ANlfRULE TO FILE
(This section of foon to be ed 0 when appellant DEFENDANT (see Pa.. HC.P.J.P. No, 1001 (7) in action before District Justice,
IF NOT USED, detach from copy of notice of appeal to be served upon appellee),
PRAECIfIE: Ta Prothonotary \
y or Deputy
Enter rule upon
Name of- appellee(s)
, appellee(s), 10 file a camplaint in this appeal
(Cammon Pleas No.
I: '~'
) within twenty (20) days after service of rule or suffer entry af judgment af nan pro~
Sifl"8ture of ,appellant (Jf ;his atJomeY Of' agent
RULE: To
. Nai(Ie 01 appel/oe( s)
, appellee(s).
.' .. ",. .- . ." '. . c/ ',,'
(1) Youare natifi~ thot':a,.jiJle is hereby entered upon you 10 file a camplaint in this appeal within twenty (20) dqysQfter'l~.dole of
service of ,this rule upon You.~~rsonal service or by certified or registered mail. ' '-', , -.; ~
I ',~
(21' If yoU do nat"iile a "complaint within this time. a JUDGMENT OF NON PROS WILL BE ENTERED AGAINST YOU'-
(311 The date af service of this rule if service was by mail is the dale of maili"ll-
Date:
,19_.
Signa1uIe 01 PmthonoIary (II' D6puty
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AOPC 312-84
courtTFILE
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PROOf OF SERVICE Of NOTICE OF APPEAL AND RULE TO FILE COMPLAINT
(This proof 01 service MUST BE FILED WITHIN TEN (10) DAYS AFTER filing the notice of appeal, Check applicabfe boxes)
COMMONWEALTH OF PENNSYLVANIA
./'" ;;. f
COUNTY OF Ie/, tit) , (; ! i)
,
; as
AFFIDAVIT: I hereby swear or affirm that I served
:ttl a copy of the NoticA~,ot Ap,peal Commcm Pleas No. ,iJ?Olry- /'f"Jrr ,upon the DIst~ ~u~tlce designated therem on
! (date of service) Ii k1 N n 7f.. j fucc , P py persoJlilI sery'ce ,D( bY(cer!i!i~,d}(registered) mail, sender's
reCeipt attached (lereto, and upon the appellee, (name) ./lc'H:(,f I" .: flI"K . ,on
l}/f(/n:l1 /~- ,y.[2i.'Z7' 0 by personal service)!'rby(.;;;;t;iie~Y(reglstered) mall, sender's receipt attached hereto,
o and further that I serv~d the Rule to Filea Complaintaccompanyl,,"giheabove Notice 01 Appeal upon the appeilee(s) towhom
the Rule was addressed on ,19_ 0 ~]f"'9:sonal"serv..l<>e'qbY (certified) (registered)
mail, sender's receipt attached hereto, /1' '.l ()><(\ / :'
SWORN (AFFIRMED) AND SUBSCRIBED.BEFORE ME !. t/./J /. "" /. .A"" J
"'1) sot: r1f I l I. , \,,0'.' "',, "A:",,) ,-'
THIS Qc. DAY OF "Y'rt1 ,tll~ ..' I' i V' '.'"'
_. /} " f)' . 11 /) . . Signatura of affiant
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Signature of offici8! bef~)(e whom affidavit was made
l\lc1-6.r't @vJ,I;c
Titla of official
My commission expires on
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NOTARIAL SEAL
LINDA H. EAKLE, Notary p"l,,"C
Baro of Chamber.burg, FrankL1 Co.
My Commi..ian Expires October 2, 2000
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