COMMONWEALTH OF PENNSYLVANIA
Mag. Dist. No:
AMOUNT DATE PAID
FILING COSTS $
SERVICE COSTS $
CONSTABLE ED. $
Pa.R.C.P.M.D.J. No. 206 sets forth those costs recoverable by the prevailing party.
To The Defendant:
The above named plaintiff(s) asks judgment against you for $__________________ together with costs
upon the following claim (Civil fines must include citation of the statute or ordinance violated):
I, ______________________________________ verify that the facts set forth in this complaint are true and correct to the
best of my knowledge, information, and belief. This statement is made subject to the penalties of Section 4904 of the
Crimes Code (18 PA. C.S. § 4904) related to unsworn falsification to authorities.
If you are disabled and require a reasonable accommodation to gain access to the Magisterial District Court and its services,
please contact the Magisterial District Court at the above address or telephone number. We are unable to provide
If you intend to enter a defense to this complaint, you should notify this office immediately at the above telephone number. You
must appear at the hearing and present your defense. Unless you do, judgment may be entered against you by default.
If you have a claim against the plaintiff which is within the magisterial district judge jurisdiction and which you intend to assert at the
hearing, you must file it on a complaint form at this office at least five days before the date set for the hearing.
(Signature of Plaintiff or Authorized Agent)
The plaintiff's attorney shall file an entry of appearance with the magisterial district court pursuant to Pa.R.C.P.M.D.J. 207.1
I certify that this filing complies with the provisions of the Case Records Public Access Policy of the Unified Judicial System
of Pennsylvania that require filing confidential information and documents differently than non-confidential information and
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