FIRM NAME BY: ATTORNEY'S NAME IDENTIFICATION NO.: 00000 STREET ADDRESS PHILADELPHIA, PA 19100 TELEPHONE NO.: 000-000-0000
Attorney for
PLAINTIFF v. DEFENDANT
: : : : :
PHILADELPHIA COUNTY COURT OF COMMON PLEAS TRIAL DIVISION Term, 20 NO.
Proof of Service
I hereby certify that I have served a copy of this motion upon all other parties or their counsel and the trial judge by (type of service) The names and addresses of all persons served are as follows: on .
Attorney Address
Court Reporter Address
Attorney for
Honorable Trial Judge Address
Director of Court Reporters Address
Name of Attorney
Attorney for