SERVICEMEMBERS CIVIL 
RELIEF ACT AFFIDAVIT 

Vs. 

_______________________________________
(Party name as displayed in case caption)  

______________________________ 
Docket/Case No. 

_______________________________________
(Party name as displayed in case caption)  

______________________________ 
Court 

I, _______________________________________, the undersigned, certify and declare as follows: 

1) This affidavit is made pursuant to the Servicemembers Civil Relief Act (50 U.S.C. § 3931).
2)
3) As of the current date: (check one)

I am the plaintiff in the above-captioned matter.

a)
b)
c)

I have personal knowledge that the defendant named above is in military service.
I have personal knowledge that the defendant named above is not in military service.
I am unable to determine whether the defendant named above is in military service.

4) The following facts support the above statement (explain how you know the defendant is or is not in

military service, or, if unable to make a determination, the steps you took to investigate the
defendant’s military status):

I verify that the statements herein are true and correct to the best of my knowledge, information and 
belief.  I understand that false statements herein are made subject to the penalties of Section 4904 of the 
Crimes Code (18 Pa. C.S. § 4904) relating to unsworn falsification to authorities. 

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 or documents. 

_________________________________ 
Signature 

NOTE: 

For the definition of military service, see 50 U.S.C. § 3911(2). 

The Servicemembers Civil Relief Act website (https://scra.dmdc.osd.mil) is a website maintained 
by the Department of Defense that may be used to determine the defendant’s military status. 

See 50 U.S.C. § 3931(c) for additional penalties for knowingly making or using a false affidavit.