COMMONWEALTH OF PENNSYLVANIA COURT OF COMMON PLEAS County Of
PLAINTIFF:
NAME and ADDRESS
VS.
DEFENDANT:
NAME and ADDRESS
Common Pleas Docket No.
TENANT'S SUPERSEDEAS AFFIDAVIT (NON-SECTION 8) FILED PURSUANT TO Pa.R.C.P.M.D.J. No. 1013C(2)
I,
(print name and address here),
have filed a praecipe for a writ of certiorari to review a magisterial district court judgment awarding to my landlord possession of real property that I occupy, and I do not have the financial ability to pay the lesser of three (3) times my monthly rent or the judgment for rent awarded by the magisterial district court. My total household income does not exceed the income limits set forth in the instructions for obtaining a stay pending issuance of a writ of certiorari and I have completed an in forma pauperis (IFP) affidavit to verify this. I have/have not (cross out the one that does not apply) paid the rent this month. I verify that the statements made in this affidavit are true and correct to the best of my knowledge, information and belief. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. ยง 4904, relating to unsworn falsification to authorities.
__________ Date
__________________________ SIGNATURE OF TENANT
AOPC 312-08 (D)