Mag. Dist. No:
MDJ Name:

Address:

Telephone:

Address if any:

COMMONWEALTH OF PENNSYLVANIA 
COUNTY OF

REQUEST FOR ORDER FOR 
POSSESSION

_________________________
v.

_________________________

Docket No:

Case Filed:
Time Filed: 
Date Order Filed:

Judgment Amount
Costs in Original LT Proceeding 
Costs in this Proceeding
 Attorney Fees

$__________________
$__________________
$__________________
$__________________

Total

$__________________

TO THE MAGISTERIAL DISTRICT JUDGE: 
The Landlord(s) named below, having obtained a judgment for possession of real property located at:

Requests that you issue an ORDER FOR POSSESSION for such property.

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.

Landlord:  __________________________

Date:

Landlord Signature:

AOPC 311A

1

FREE INTERPRETER
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