The notice and acknowledgment of receipt of subpoena by mail required by Rule 234.2(b)(3) shall be substantially in the following form:

(Caption)

NOTICE

To

____________

(Name of person to be served)

The enclosed subpoena is served pursuant to Pennsylvania Rule of Civil Procedure 234.2(b)(3). Complete the acknowledgment part of this form and return the copy of the completed form to the sender in the enclosed self-addressed stamped envelope.

Sign and date the acknowledgment. If you are served on behalf of a partnership, unincorporated association, corporation or similar entity, indicate under your signature your relationship to that entity. If you are served on behalf of another person and you are authorized to receive the subpoena, indicate under your signature your authority.Date Notice Mailed:

____________

_________________________

Party serving subpoena or

Attorney for Party

ACKNOWLEDGMENT OF RECEIPT OF SUBPOENA

I acknowledge receipt of a copy of the subpoena in the above captioned matter. Date:

____________

,

___

_________________________

Signature

_________________________

Relationship to entity or

authority to receive the

subpoena