NAME and ADDRESS 
NON ak ADRÈS 
 
 

 
 
 

 

 
 
 

 

 
 
 

 

 
 
 

 

VS. / KONT 

NAME and ADDRESS 
NON ak ADRÈS 
 
 

 

 

 

 

 
 
 

 

 
 
 

 

LANDLORD: 
MÈT KAY LA: 

 

 

 
 
 

 

 

 

 

     

     

 

TENANT: 
LOKATÈ: 
 

Common Pleas Docket No. 
Nimewo Lis Dosye Tribinal Defans an Komen. 

COMMONWEALTH OF PENNSYLVANIA 
KOMINOTE PENNSYLVANIA 

COURT OF COMMON PLEAS 
TRIBINAL DEFANS AN KOMEN 

ounty Of 

Konte 

    C

     

 

 

 

SECTION 8 TENANT’S SUPERSEDEAS 
AFFIDAVIT FILED PURSUANT TO 
Pa.R.C.P.M.D.J. No. 1013C(2) 

AFIDAVID SUPERSEDEAS LOKATÈ 
SEKSYON 8 KI DEPOZE SELON 
Pa.R.C.P.M.D.J. NIMEWO 1013C(2) 

 

I, _____________________________ 
__________________________________ (print 
name and address here), have filed a praecipe 
for a writ of certiorari to review a magisterial 
district court judgment awarding my landlord 

Mwen, _________________________ 
__________________________________ (ekri 

non ak adrès ak lèt detache la a), te depoze yon 
praecipe pou yon òdonans certiorari pou 
egzamine yon jijman tribinal distri majistral ki 

possession of real property that I occupy, and I 
do not have the financial ability to pay the lesser 

bay mèt kay mwen an posesyon byen imobilye 
mwen okipe a, epi mwen pa gen kapasite 

of three times my monthly rent or the actual rent 
in arrears. My total household income does not 

finansyè pou m peye montan ki pi piti nan twa 
fwa kòb lwaye chak mwa mwen an oswa kòb 

exceed the income limits set forth in the 
instructions for obtaining a stay pending 
issuance of writ of certiorari and I have 
completed an in forma pauperis (IFP) affidavit to 
verify this. I have/have not (cross out the one 
that does not apply) paid the rent this month. 

lwaye reyèl la an reta. Revni total moun nan kay 
mwen pa depase limit revni ki prezante nan 

enstriksyon siplemantè yo pou m jwenn yon 
sispansyon annatandan yo bay yon òdonans 
certiorari epi mwen te ranpli yon afidavid in 
forma pauperis (IFP) pou mwen verifye sa. 

Mwen te/pa t (bife sa ki pa aplike a) peye kòb 
lwaye mwa sa a. 

The total amount of monthly rent that I 
personally pay to the landlord is $ __________. I 

Montan total kòb lwaye chak mwa mwen 

peye mèt kay la pèsonèlman se $ __________. 

hereby certify that I am a participant in the 
Section 8 program and I am not subject to a final 
(i.e., non-appealable) decision of a court or 
government agency that terminates my right to 
receive Section 8 assistance based on my  

Mwen sètifye nan dokiman sa a mwen se yon 
patisipan nan pwogram Seksyon 8 la epi mwen 
pa gen yon desizyon final (sa vle di, san apèl 
jiridik) yon tribinal oswa ajans gouvènman ki 
mete fen nan dwa m genyen pou m benefisye  

respekte règ pwogram lan. 

  a

ailure to comply with program rules. 

sistans Seksyon 8 ki baze sou lefètke mwen pa 

I verify that the statements made in this 

Mwen verifye deklarasyon ki fèt nan 

affidavit are true and correct to the best of my 
knowledge, information, and belief. I understand 

afidavid sa a se verite epi yo kòrèk selon pi bon 
konesans, enfòmasyon ak kwayans mwen. 

that false statements herein are made subject to 
the penalties of 18 Pa.C.S. § 4904, relating to 

Mwen konprann fo deklarasyon mwen fè nan 
dokiman sa a ap genyen penalite Seksyon 18 

unsworn falsification to authorities. 

Pa.C.S. § 4904, ki gen rapò ak bay otorite yo fo 
deklarasyon ki pa fèt sou sèman. 

_________________ 

 

Date / Dat 

___________________________________________ 
SIGNATURE OF TENANT / SIYATI LOKATÈ A 

  f

    _

                                                                           

AOPC 312-08 (C)