COMMONWEALTH OF PENNSYLVANIA  
KOMINOTE PENNSYLVANIA  

COURT OF COMMON PLEAS 
TRIBINAL DEFANS AN KOMEN 

County Of 
Konte 

LANDLORD: 
MÈT KAY LA: 

NAME and ADDRESS 

NON ak ADRÈS 

 

 

 

 

TENANT: 
LOKATÈ: 

VS. / KONT 

NAME and ADDRESS 

NON ak ADRÈS 

 

 

Common Pleas Docket No. 
Nimewo Lis Dosye Tribinal Defans an Komen 

TENANT’S SUPERSEDEAS AFFIDAVIT (NON-
SECTION 8) FILED PURSUANT TO 
Pa.R.C.P.M.D.J. No. 1008C(2) 

AFIDAVID SUPERSEDEAS LOKATÈ (KI PA 
SEKSYON 8) KI DEPOZE SELON  
Pa.R.C.P.M.D.J. NIMEWO 1008C(2) 

I, _________________________ 

__________________________________ 

(print name and address here), have filed a 

Mwen, _________________________ 

__________________________________ (ekri 

non ak adrès ak lèt detache la a), te depoze yon 

notice of appeal from a magisterial district court 

avi pou apèl jiridik nan yon jijman tribinal distri 

judgment awarding to my landlord possession of 

majistral ki bay mèt kay mwen an posesyon 

real property that I occupy, and I do not have 

byen imobilye mwen okipe a, epi mwen pa gen 

the financial ability to pay the lesser of three 

kapasite finansyè pou m peye montan ki pi piti 

times my monthly rent or the judgment for rent 

nan twa fwa kòb lwaye chak mwa mwen an 

awarded by the magisterial district court. My 

oswa jijman pou kòb tribinal distri majistral la 

total household income does not exceed the 

akòde. Revni total moun nan kay mwen pa 

income limits set forth in the supplemental 

depase limit revni ki prezante nan enstriksyon 

instructions for obtaining a stay pending appeal 

siplemantè yo pou m jwenn yon sispansyon 

and I have completed an in forma pauperis 

(IFP) affidavit to verify this. I have/have not 

annatandan yon apèl jiridik epi mwen te ranpli 

yon afidavid in forma pauperis (IFP) pou mwen 

(cross out the one that does not apply) paid the 

verifye sa. Mwen te/pa t (bife sa ki pa aplike a) 

rent this month. 

peye kòb lwaye mwa sa a. 

 

 

I verify that the statements made in this affidavit 

Mwen verifye deklarasyon ki fèt nan afidavid sa a 

are true and correct to the best of my knowledge,  

se verite epi yo kòrèk selon pi bon konesans,  

   

         

 

 

 

sou sèman. 

  e

nformation, and belief. I understand that false 

nfòmasyon ak kwayans mwen. Mwen konprann 

statements herein are made subject to the 

fo deklarasyon mwen fè nan dokiman sa a ap 

penalties of 18 Pa.C.S. § 4904, relating to unsworn 

genyen penalite Seksyon 18 Pa.C.S. § 4904, ki 

falsification to authorities. 

gen rapò ak bay otorite yo fo deklarasyon ki pa fèt 

SIGNATURE OF TENANT / SIYATI LOKATÈ A 

ate / Dat 

  D

 

 

 

  i

                                                                         

OPC 312-08 (B) 

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