_________________________

(Specify courtroom or other place) at

____________

, Pennsylvania, on

____________

at

___

o’clock,

___

. M., to testify on behalf of

____________

in the above case, and to remain until excused.

______________________________________

_________________________

.

If you fail to attend or to produce the documents or things required by this subpoena, you may be subject to the sanctions authorized by Rule 234.5 of the Pennsylvania Rules of Civil Procedure, including but not limited to costs, attorney fees and imprisonment. Requested by: ______________________________________

(Attorney’s name, address, telephone number and identification number)

BY THE COURT,

Date:

____________

By

____________

Seal of the Court (Name of Prothonotary)

Return of Service: (Reverse side of Subpoena)

On the

________

day of

________

,

___

, I

________

, served

________

with the fore(name of person served)

going subpoena by: (Describe method of service)

___________________________

______________________

.

I verify that the statements in this return of service are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S.A. § 4904 relating to unsworn falsification to authorities.

Date:

_____________

…

_____________

(signature)