Forms
Civil Division
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. ยง4904 relating to unsworn falsification to authorities. DATE: __________________________ ________________________________________ , Esquire Attorney for Petitioner TERM, 20___
NO:
236