(Caption) 

NOTICE OF HEARING AND ORDER 

YOU HAVE BEEN SUED IN COURT. If you wish to defend against the claims 
set forth in the following papers, you must appear at the hearing scheduled herein. If 
you fail to do so, the case may proceed against you and a FINAL order may be entered 
against you granting the relief requested in the petition. In particular, you may be 
evicted from your residence, prohibited from possessing any firearm, other weapon, 
ammunition, or any firearm license, and lose other important rights, including custody 
of your children. A protection order granted by a court may be considered in 
subsequent proceedings under Title 23 (Domestic Relations) of the Pennsylvania 
Consolidated Statutes, including child custody proceedings under Chapter 53 (relating 
to custody) and Child Protective Services Law proceedings under Chapter 63 (related 
to juvenile matters).

A hearing on the matter is scheduled for the 

 day of 

, 20      ,  

at _.m.  in Courtroom 

at 

 Courthouse, Pennsylvania. 

If an order of protection has been entered, you MUST obey the order until it is 
modified or terminated by the court after notice and hearing. If you disobey this order, 
the police or sheriff may arrest you. Violation of this order may subject you to a charge 
of indirect criminal contempt under 23 Pa C.S. § 6114. Violation may also subject you 
to prosecution and criminal penalties under the Pennsylvania Crimes Code. Under 
federal law, 18. U.S.C. § 2265, this order is enforceable anywhere in the United States, 
tribal lands, U.S. Territories, and the Commonwealth of Puerto Rico. If you travel 
outside of the state and intentionally violate this order, you may be subject to federal 
criminal proceedings under the Violence Against Women Act. 18 U.S.C. §§ 2261-2262. 

If this order directs you to relinquish any firearm, other weapon, ammunition, or 
any firearm license to the sheriff or the appropriate law enforcement agency, you may 
do so upon service of this order. As an alternative, you may relinquish any firearm, 
other weapon, or ammunition listed herein to a third party provided you and the third 
party first comply with all requirements to obtain a safekeeping permit. 23 
Pa.C.S. § 6108.3. You must relinquish any firearm, other weapon, ammunition, or 

any firearm license listed in the order no later than 24 hours after service of the order. 
If, due to their current location, firearms, other weapons, or ammunition cannot 
reasonably be retrieved within the time for relinquishment, you must provide an 
affidavit to the sheriff or the appropriate law enforcement agency listing the firearms, 
other weapons, or ammunition and their current location no later than 24 hours after 
service of the order. Failure to timely relinquish any firearm, other weapon, 
ammunition, or any firearm license shall result in a violation of this order and may 
result in criminal conviction under the Uniform Firearms Act, 18 Pa.C.S. § 6105. 

NOTICE: Even if this order does not direct you to relinquish firearms, you 

may be subject to federal firearms prohibitions and federal criminal penalties 
under 18 U.S.C. § 922(g)(8) or state firearms prohibitions and state criminal penalties 
under 18 Pa.C.S. § 6105.

YOU HAVE THE RIGHT TO HAVE A LAWYER REPRESENT YOU AT THE 
HEARING, HOWEVER, THE COURT WILL NOT APPOINT A LAWYER FOR YOU. 
YOU HAVE THE RIGHT TO PRESENT EVIDENCE AT THE HEARING, INCLUDING 
SUBPOENAING WITNESSES TO TESTIFY ON YOUR BEHALF. 

YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT
HAVE A LAWYER, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW. 
THIS OFFICE CAN PROVIDE YOU WITH INFORMATION ABOUT HIRING A 
LAWYER. IF YOU CANNOT AFFORD TO HIRE A LAWYER, THIS OFFICE MAY BE 
ABLE TO PROVIDE YOU WITH INFORMATION ABOUT AGENCIES THAT MAY 
OFFER LEGAL SERVICES TO ELIGIBLE PERSONS AT A REDUCED FEE OR NO 
FEE. IF YOU CANNOT FIND A LAWYER, YOU MAY HAVE TO PROCEED WITHOUT 
ONE. 

County Lawyer Referral Service 
 

[Insert Street Address] 

[Insert City, State, Zip Code] 

[Insert Phone] 

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