The Legal Innovation & Technology Lab's Form Explorer ^Beta @ Suffolk Law School Last updated 2023-04-02

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Here is the text we could read:

 

Commonwealth of Pennsylvania

 

Pennsylvania

 ثلونموك

 

Magisterial District Court No. ____________ of ___________________ County
 
________________ ةعطاقم يف _____________ مقر ةيميلقلاا حلصلا ةمكحم

_______________________ 
 
 
 
 
 
 
 
 
 
Vs./ دض               
 
 
 
 
________________________ 
 
 
 
 

 
 
 
 

 

 

 
 
 
 
 
 
 

 
 
 
 
 
 
 

 
 
 
 
 
 
 

: 
: 
: 
: 
: 
: 
: 

Case number: ________________ 
ىوعدلا مقر 
 
:

 

Interpreter Request Notice – Magisterial District Judge
 
ةمكحم يضاق
ا
 
ل
ص
ل
ح
ا
 
لا
ق
ل
ي
م
ي
ة
 
-
 
يروف مجرتم بلطب راعشا
 

nterpreter services are requested in the above 
captioned matter as follows: 

 

:يلي امك هلاعأ ةدراولا ةيضقلا يف ةيروفلا ةمجرتلا تامدخ بلط مت دقل

earing Date: __________________ Time: _________ Courtroom/Office: _____________________________ 
 
 
سلاا ةسلج خيرات
ت
م
ا
ع
:
كملا/ةمكحملا ةعاق
ت
ب
:
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

                                

                    

ةعاسلا
:

 

 

DJ Court Address: ________________________________________________________________________ 
 
 
ةمكحم يضاق ناونع
ا
 
ل
ص
ل
ح
ا
 
لا
ل
ق
ي
م
ي
ة
:

hone: ________________ Email: _____________________________________________________________ 
 
:
ا
                                   
ل
ه
ت
ا
ف

ورتكللإا ديربلا
ن
ي
:
 
 
 
 
 
 
 
 
 
 

 

 

ase/proceeding type: (Select criminal or civil and 

لك دنع ةراشا عض مث يندم مأ يئانج رتخا(
 
م
 
ا
 

  _

  I

    H

  M

  P

  C

check all that apply): 
 
Criminal:  

 Bail   
 Preliminary Hearing   
 Arraignment   
 Misdemeanor   
 Summary   
 Plea   
 ARD 
 Other: ____________________ 

 

Civil:  

 Landlord/Tenant  
 PFA/PSVI  

 Traffic  
 Civil Complaint  
 Small Claims  
 Other: ___________ 

 

 

 

 

 
  ةلافك
  ةيديهمت ةسلج
 
  ةمهتلا ىلع ةباجلإل ةمكحملا مامأ مهتملا راضحا
 
  ةحنج
  لجعتسم
 
  مهتملا باوج
 
 لجعم يليهأت بيترت
 
:كلذ ريغ

____________________

ARD

 

 

 

 

:ءارجلاا/ةيضقلا عون
ي
ط
ن
ب
ق
 
)

 

:يئانج

  
 
 
 
 
 
 
 
 

  
 
 

:يندم

 ديدهتلا وأ فنعلا نم ةيامحلا / )

PFA

  

رجأتسم/رجؤم
( ةءاسلإا نم ةيامحلا
)  
( يسنجلا

PSVI

  

 ريس  
 
 
 

ةيندم ىوكش
ىرغصلا اياضقلا
 
:كلذ ريغ

  
___________

 

AOPC/ICP – 012   Rev. 12/13     
Interpreter Request Notice – Magisterial District Judge (English/Arabic)-Translated on 6/21/2021                                                                                                                                                                                                        

 
Name of person (LEP) needing the interpreter: 
_________________________________________ 
 
LEP relationship to case:  

 
 مجرتم جاتحي يذلا
__ 

____________________________________ 

)ةيزيلجنلاا ةغللا يف ةءافكلا دودحم( صخشلا مسا
:يروف

 

  

:ةيضقلاب ةيزيلجنلاا ةغللا يف ةءافكلا دودحم صخشلا ةقلاع
 

 Defendant/Respondent  
 Plaintiff/Petitioner 
   
 Witness     
 Victim 
 Juvenile    
 Parent/Person in loco parentis    
 other: ______________________ 

 
Language (Select foreign or sign language and 
provide all requested information):  
 
Foreign language:  

 Language spoken: ____________________  
Dialect (if applicable): _________________ 

 

Sign language:  

 American Sign Language 
 Other non-ASL: ________________  

 

 

 Foreign sign language (country): 

___________________ 

 
Country of origin: ___________________________ 

Region/Province (if known): __________________ 
 
Does the LEP speak a second language?  Yes  No 

Other language: ________________________ 
 
Please provide additional information about the 
communication preferences of the limited English 
speaker. 

 

 

 

 

 

 

 

 

بيجُملا/هيلع ىعدملا
سمتلملا/يعدملا
دهاش
 
 
ةيحضلا
   ثدح
 صخشلا / نيدلاولا دحأ
 
:كلذ ريغ

 
 

 
 
 
 
 
 
 

  
 
 
 

)رملأا يلو(

 
in loco parentis
______________________

 

مولعملا
ا
ت
 
 

لك 
 
وزو ةراشلإا ةغل وأ ةيبنجلأا ةغللا رتخا(
د
 
ةغللا
ّ
طملا
ل
و
ب
ة
)
:

  

  

____________________

 

_________________

 

  
:ةثدحتُملا ةغللا
:)كلذ قبطنا اذإ( ةجهللا

:ةيبنجلأا ةغللا
 

 

  

 
ةيكيرملأا ةراشلإا ةغل
:ةيكيرملأا ةراشلإا ةغل ريغ ىرخأ ةراشإ ةغل
  
 
:)ةلودلا( ةيبنجأ ةراشإ ةغل

:ةراشلإا ةغل
 
 
________________
 

 

 

___________________

 

_________________________

 

:لصلأا دلب

 

__________________

 

:)اًفورعم كلذ ناك نا( ميلقلاا/ةقطنملا

 

؟ةيناث ةغل ثدحتي ةيزيلجنلاا ةغللا يف ةءافكلا دودحم صخشلا له
  
 معن  لا 
 
:ىرخأ ةغل

________________________

 

 ىدل ةلضفملا لاصتلاا قرط لوح ةيفاضا تامولعم ميدقت ىجري
 
.ةيزيلجنلاا ةغللاب ثدحتلا ةءافك دودحم صخشلا

 

________________________________ 
Print Requestor’s Name 
 
ب
مدقم مسا بتكا
 
ل
ا
ط
ل
   

 

 

 

 

 

__________________ 
Date 
 
 
ا
ل
ت
ا
ر
ي
خ
        
 

 

 

 

___________
Phone 
ا
ل
        
ه
ا
ت
ف

 

___________________

 

________________________________ 
Requestor’s Signature  
 
ب
مدقم عيقوت
ا
 
ل
ط
ل
 
AOPC/ICP – 012   Rev. 12/13     
Interpreter Request Notice – Magisterial District Judge (English/Arabic)-Translated on 6/21/2021                                                                                                                                                                                                        

______________________________ 
E-mail 
  
ورتكللاا
 
ن
ي
ا
      
ل
ب
ر
ي
د

__________________ 
Title 
 
 
ا
ل
ل
ق
ب
         
 

      
 

 

 

 

 

 

 

 

 

 

            _

  _

In the Court of Common Pleas of ___________________ County

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): 2
Fields(s): 96
Average fields per page: 48
Reading Level: Grade 12
LIST Grouping(s): GO-00-00-00-00.

Use our Rate My PDF tool to learn more. Go beyond the above insights and learn more about this or any pdf form at RateMyPDF.com, includes: counts of difficult words used, passive voice decetion, and suggestions for how to make the form more usable.

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.

text__1 was Text1 (0.97 conf)
text__2 was Text1A (0.32 conf)
text__3 was Text2 (0.35 conf)
text_b was Text2B (0.34 conf)
text__4 was Text3 (0.35 conf)
text__5 was Text4 (0.35 conf)
text__6 was Text5 (0.35 conf)
text__7 was Text6 (0.35 conf)
text__8 was Text7 (0.35 conf)
text__9 was Text8 (0.35 conf)
text__10 was Text9 (0.35 conf)
text__11 was Text10 (0.35 conf)
text__12 was Text11 (0.35 conf)
check_box__1 was CheckBox1 (0.52 conf)
check_box__2 was CheckBox1T (0.52 conf)
check_box__3 was CheckBox2 (0.37 conf)
check_box__4 was CheckBox2T (0.41 conf)
check_box__5 was CheckBox3 (0.37 conf)
check_box__6 was CheckBox3T (0.41 conf)
check_box__7 was CheckBox4 (0.37 conf)
check_box__8 was CheckBox4T (0.41 conf)
check_box__9 was CheckBox5 (0.37 conf)
check_box__10 was CheckBox5T (0.41 conf)
check_box__11 was CheckBox6 (0.37 conf)
check_box__12 was CheckBox6T (0.41 conf)
check_box__13 was CheckBox7 (0.37 conf)
check_box__14 was CheckBox7T (0.41 conf)
check_box__15 was CheckBox8 (0.37 conf)
text__13 was Text12 (0.35 conf)
check_box__16 was CheckBox8T (0.41 conf)
text__14 was Text12T (0.41 conf)
check_box__17 was CheckBox9 (0.37 conf)
check_box__18 was CheckBox9T (0.41 conf)
check_box__19 was CheckBox10 (0.37 conf)
check_box__20 was CheckBox10T (0.41 conf)
check_box__21 was CheckBox11 (0.37 conf)
check_box__22 was CheckBox11T (0.41 conf)
check_box__23 was CheckBox12 (0.37 conf)
check_box__24 was CheckBox12T (0.41 conf)
check_box__25 was CheckBox13 (0.37 conf)
check_box__26 was CheckBox13T (0.41 conf)
check_box__27 was CheckBox14 (0.37 conf)
text__15 was Text13 (0.35 conf)
check_box__28 was CheckBox14T (0.41 conf)
text__16 was Text13T (0.41 conf)
text__17 was Text14 (0.35 conf)
text__18 was Text14T (0.41 conf)
check_box__29 was CheckBox17 (0.37 conf)
check_box__30 was CheckBox17T (0.41 conf)
check_box__31 was CheckBox18 (0.37 conf)
check_box__32 was CheckBox18T (0.41 conf)
check_box__33 was CheckBox19 (0.37 conf)
check_box__34 was CheckBox19T (0.41 conf)
check_box__35 was CheckBox20 (0.37 conf)
check_box__36 was CheckBox20T (0.41 conf)
check_box__37 was CheckBox21 (0.37 conf)
check_box__38 was CheckBox21T (0.41 conf)
check_box__39 was CheckBox22 (0.37 conf)
check_box__40 was CheckBox22T (0.41 conf)
check_box__41 was CheckBox23 (0.37 conf)
text__19 was Text15 (0.35 conf)
check_box__42 was CheckBox23T (0.41 conf)
text__20 was Text15T (0.41 conf)
check_box__43 was CheckBox24 (0.37 conf)
text__21 was Text16 (0.35 conf)
check_box__44 was CheckBox24T (0.41 conf)
text__22 was Text16T (0.41 conf)
text__23 was Text17 (0.35 conf)
text__24 was Text17T (0.41 conf)
check_box__45 was CheckBox25 (0.37 conf)
check_box__46 was CheckBox25T (0.41 conf)
check_box__47 was CheckBox26 (0.37 conf)
text__25 was Text18 (0.35 conf)
check_box__48 was CheckBox26T (0.41 conf)
text__26 was Text18T (0.41 conf)
check_box__49 was CheckBox27 (0.37 conf)
check_box__50 was CheckBox27T (0.41 conf)
text__27 was Text19 (0.35 conf)
text__28 was Text19T (0.41 conf)
text__29 was Text20 (0.35 conf)
text__30 was Text20T (0.41 conf)
text__31 was Text21 (0.35 conf)
text__32 was Text21T (0.41 conf)
check_box__51 was CheckBox28 (0.37 conf)
check_box__52 was CheckBox29 (0.37 conf)
check_box__53 was CheckBox28T (0.41 conf)
check_box__54 was CheckBox29T (0.41 conf)
text__33 was Text22 (0.35 conf)
text__34 was Text22T (0.41 conf)
text__35 was Text26 (0.35 conf)
text__36 was Text27 (0.35 conf)
text__37 was Text28 (0.35 conf)
text__38 was Text29 (0.35 conf)
text__39 was Text30 (0.35 conf)
text__40 was Text24 (0.35 conf)
text__41 was Text25 (0.35 conf)

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The Legal Innovation & Technology Lab's Form Explorer Beta @ Suffolk Law School Last updated 2023-04-02

In the Court of Common Pleas of ___________________ County

About This Form:

Identified Data Fields:

Create an Interactive Version of this Form:

The Legal Innovation & Technology Lab's Form Explorer ^Beta @ Suffolk Law School Last updated 2023-04-02