COMMONWEALTH OF PENNSYLVANIA 
COUNTY OF 

CIVIL COMPLAINT

PLAINTIFF:

NAME and ADDRESS

DEFENDANT:

V.

NAME and ADDRESS

Mag. Dist. No:

MDJ Name:

Address:

Telephone:

FILING COSTS

POSTAGE

SERVICE COSTS $ 

CONSTABLE ED. $ 

$ 

$ 

$ 

TOTAL

AMOUNT

DATE PAID

Docket No:

Case Filed:

Pa.R.Civ.P.M.D.J. 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.

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 
documents.

The plaintiff's attorney shall file an entry of appearance with the magisterial district court pursuant to Pa.R.Civ.P.M.D.J. 207.1

(Signature of Plaintiff or Authorized Agent)

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.

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 
transportation.

AOPC 308A

1

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