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Civil Division Forms
IN THE COURT OF COMMON PLEAS OF PHILADELPHIA COUNTY CIVIL TRIAL DIVISION : : : : : AFFIDAVIT I, _____________________________________ , Esquire, hereby state and affirm that I have complied with the Order issued on ____________________________________by the Honorable _____________________ as follows: _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ Copies of bank accounts are attached hereto. I verify that the statements in this Affidavit are made subject to the penalties of 18 Pa. C.S. §4904 relating to unsworn falsification to authorities. TERM, 20___
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Date: __________________________
________________________________________ , Esquire Attorney for Petitioner
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