Here is the text we could read:
IN THE COURT OF COMMON PLEAS OF _________________________ COUNTY
DEVAN TRIBINAL PREMYE ENSTANS NAN KONTE _________________________
FAMILY COURT DIVISION
DIVIZYON TRIBINAL KI OKIPZE AFÈ LAFANMI
CIVIL ACTION
AKSYON SIVIL
No. / Nimewo ________________________________
ROTECTION FROM ABUSE
PWOTEKSYON KONT MOVE TRETMAN
P
_____________________________________________
PLAINTIFF / PLEYAN
V. / Kont
_____________________________________________
DEFENDANT / AKIZE
AFFIDAVIT OF SERVICE
ATESTASYON KI FÈ KONNEN YO REMÈT PAPYE YO
I, _____________________________, the undersigned,
hereby state that I served a copy of the Notice of Hearing and
Order, Petition and Temporary Order in the above captioned
action upon Defendant by handing the papers to:
________________________________________________
Mwenmenm, _____________________________, ki siyen
anba la a, ak dokiman sa a mwen deklare mwen te remèt
yon kopi Avi pou Odyans ak Òdonans, Demann ak
Òdonans Tanporè nan aksyon ki mansyone piwo a ba
Akize a paske mwen te remèt papye yo ba:
_______________________________________________
at the following address:
nan adrès ki annapre la a:
________________________________________________,
______________________________________________,
__________________, Pennsylvania, ON THE ______ DAY
__________________, Pennsilvani, NAN JOU
OF _____________________________, 20_____________
AT APPROXIMATELY __________ A.M. / P.M.
I verify that the statements made in this Affidavit are true and
correct. I understand that false statements are made subject to
the penalties of 18 Pa.C.S. §4904, relating to unsworn
falsification to authorities.
___________________________, 20_____________
A APEPRÈ __________ A.M. / P.M.
Mwen konfime deklarasyon ki fèt nan Atestasyon sa a se
laverite e yo kòrèk. Mwen konnen si mwen fè nenpòt
deklarasyon ki fo, yo kapab pran sanksyon kont mwen
dapre 18 Pa.C.S.A. §4904, yon lalwa ki gen rapò ak bay
leta enfòmasyon ki fo san prete sèman.
_______________________________________________
Signature / Siyati
_______________________________________________
Address / Adrès
Date / Dat: ____________________________________
HIS FORM MUST BE COMPLETED AND SIGNED BY THE PERSON WHO SERVES THE DEFENDANT WITH
THE NOTICE OF HEARING AND ORDER, PETITION AND TEMPORARY ORDER. IT MUST BE BROUGHT TO
COURT ON THE HEARING DATE.
OUN KI TE REMÈT AKIZE A AVI POU ODYANS AK LÒD, DEMANN AK LÒD TANPORÈ A DWE RANPLI EPI SIYEN
FÒM SA A. NAN DAT ODYANS LA, YO DWE VINI AK LI NAN TRIBINAL LA.
ENGLISH/HAITIAN PFA Affidavit
Pa. R.C.P. 1905(d) Rev. 11-08
AOPC Rev. 6-2011
_
_
T
M
Haitian Creole PFA Service Affidavit
This info page is part of the LIT Lab's Form Explorer project. It is not associated with the Pennsylvania state courts.
To learn more about the project, check out our about page.
Downloads: You can download both the original form (last checked 2023-03)
and the machine-processed form with normalized data fields.
About This Form:
- Sourced from www.pacourts.us (2023-03)
- Page(s): 1
- Fields(s): 23
- Average fields per page: 23
- Reading Level: Grade 8
- LIST Grouping(s):
GO-00-00-00-00.
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Identified Data Fields:
We have done our best to automaticly identify and name form fields according to our naming conventions.
When possible, we've used names tied to our question library. See e.g., user1_name.
If we think we've found a match to a question in our library, it is highlighted in green. Novel names are auto generated. So, you will probably need to edit some of them if you're trying to stick to the convention.
Here are the fields we could identify.
deva_n_tribina_l_premy_e_enstan_na_konte was DEVAN TRIBINAL PREMYE ENSTANS NAN KONTE (0.68 conf)county was COUNTY (0.39 conf)plaintif_f_pleyan was PLAINTIFF PLEYAN (0.34 conf)defendan_akize was DEFENDANT AKIZE (0.41 conf)nimewo was No Nimewo (0.45 conf)hereby_state_notice_hearing was hereby state that I served a copy of the Notice of Hearing and (0.44 conf)anba_la_ak_dokiman_sa_mwen_deklare_te_rem was anba la a ak dokiman sa a mwen deklare mwen te remèt (0.49 conf)following_address was at the following address (0.37 conf)nan_adr_ki_annapre_la was nan adrès ki annapre la a (0.51 conf)pennsylvania_n was Pennsylvania ON THE (0.40 conf)day was DAY (0.34 conf)pennsilvani_na_n_jou was Pennsilvani NAN JOU (0.52 conf)of was OF (0.38 conf)approximately was AT APPROXIMATELY (0.43 conf)undefined__1 was undefined (0.38 conf)pm was AM PM (0.26 conf)unknown__1 was 1 (0.38 conf)unknown__2 was 2 (0.38 conf)undefined__2 was undefined_2 (0.39 conf)p was AM PM_2 (0.30 conf)address_adr was Address Adrès (0.36 conf)date_dat was Date Dat (0.33 conf)text was Text1 (0.35 conf)
We've done our best to group similar variables togther to avoid overwhelming the user.
Suggested Screen 0:
deva_n_tribina_l_premy_e_enstan_na_kontecountyanba_la_ak_dokiman_sa_mwen_deklare_te_remnan_adr_ki_annapre_lapennsylvania_npennsilvani_na_n_joudate_dat
Suggested Screen 1:
Suggested Screen 2:
Suggested Screen 3:
plaintif_f_pleyandefendan_akizenimewohereby_state_notice_hearingfollowing_addressdayofundefined__1unknown__1unknown__2undefined__2address_adr
Suggested Screen 4:
Suggested Screen 5:
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