COMMONWEALTH OF PENNSYLVANIA 
COUNTY OF 

REQUEST FOR DETERMINATION 
OF ABANDONMENT

Mag. Dist. No: 
MDJ Name:

Address:

Telephone:

_________________________
v.

_________________________

Docket No:

Case Filed:

TO THE MAGISTERIAL DISTRICT JUDGE: 

 The Landlord(s) in the above-captioned matter requests that you issue a Determination of Abandonment for 

the manufactured home and property located at:

__________________________________________________________________________________________

based upon the following:

__ 1.  The resident has been absent from the home for at least 30 days;

__ 2.  The resident has not paid rent for at least 30 days from the date it was due; and, one or more of the following     

   circumstances exists:

__ a.  Termination of electric or water service to the home, and other utility or payment of services to 

    the community owner has occurred;

__ b.  Home insurance has been canceled;

__ c.  Most or all personal property have been removed from the home; or

__ d.  Other indicia of abandonment:

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.

Date

Signature of Landlord

AOPC 334

1

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