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COMMONWEALTH OF PENNSYLVANIA COURT OF COMMON PLEAS Judicial District, County of

WRIT OF CERTIORARI TO MAGISTERIAL DISTRICT JUDGE
COMMON PLEAS No.

PRAECIPE FOR A WRIT OF CERTIORARI
NAME OF PARTY FILING THIS PRAECIPE AND OBTAINING THIS WRIT DOCKET No. DATE JUDGMENT RENDERED IN THE CASE OF (Plaintiff) vs. (Defendant)

The party named above claim that with respect to the above proceedings there was:
lack of jurisdiction over the subject matter improper venue lack of jurisdiction over

(Check applicable box or boxes)
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(Name of party)

such gross irregularity of procedure as to make the judgment void

PRAECIPE: To the Prothonotary Issue a Writ of Certiorari directing transmit to you a certified true copy of the record of the proceedings named above. _____________________________________________
(Signature of party filing praecipe or attorney or agent) , Magisterial

District Judge, to

WRIT OF CERTIORARI TO:
__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

, Magisterial District Judge

1. You are hereby directed by this writ to transmit to the Prothonotary of this Court of Common Pleas, within ten (10) days after you receive this writ, a certified true copy of the record of the proceedings named above. 2. This writ, when received by you, will operate as a SUPERSEDEAS to the judgment for possession in this case. This block will be checked ONLY when this notation is required under Pa.R.C.P.D.J. No. 1013B. Date delivered for service
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, 20
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.

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(Signature of Prothonotary or Deputy)

COURT FILE

PROOF OF SERVICE OF WRIT OF CERTIORARI
(This proof of service MUST BE FILED WITHIN FIVE (5) DAYS AFTER delivery of the writ for service) COMMONWEALTH OF PENNSYLVANIA (Check applicable boxes) COUNTY OF ; ss
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AFFADIVIT: I hereby (swear) (affirm) that I served the Writ of Certiorari, Common Pleas No. the Magisterial District Judge to whom it was directed on , 20 , by personal service, (registered) mail, sender's receipt attached hereto. (SWORN) (AFFIRMED) AND SUBSCRIBED BEFORE ME THIS DAY OF , 20 .
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, upon by (certified)

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(Signature of affiant)

_______________________________________________
(Signature of official before whom affidavit was made)

_______________________________________________
(Title of official)

My commission expires on
AOPC 25-05

, 20

.
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