IN THE COURT OF COMMON PLEAS OF LEHIGH COUNTY, PENNSYLVANIA

CIVIL DIVISION

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Plaintiff	:
vs.	:	File No.
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Defendant	:

PRAECIPE TO PROCEED IN FORMA PAUPERIS

To the Clerk of Judicial Records – Civil Division:

I, , attorney for the party proceeding in forma pauperis, certify that I believe the party is unable to pay the costs and that I am providing free legal service to the party

Attorney for Plaintiff / Defendant

(Rev. 2/12)

IN THE COURT OF COMMON PLEAS OF LEHIGH COUNTY, PENNSYLVANIA

Rachel A Wotring

2012-02-06