Rule 122. Content and Form of Proof of Service.
(a) Content.—A proof of service shall contain a statement of the date and manner of service and of the names of the persons served.
(b) Form.—Each name and address shall be separately set forth in the form of a mailing address, including applicable zip code, regardless of the actual method of service employed. The name, address and telephone number of the serving party shall be similarly set forth, followed by the attorney’s registration number. The telephone number of each person served shall not be noted next to the person’s name. A proof of service may be in substantially the following form:
I hereby certify that I am this day serving the foregoing document upon the persons and in the manner indicated below, which service satisfies the requirements of Pa. R.A.P. 121:
| Service by first class mail addressed as follows: | Service in person as follows: |
| Richard Row, Esquire (215) 555-1234 | John Smith, Esquire |
| 123 East Walnut Street | Counsel |
| Philadelphia, Pa. 19175 | Pennsylvania Public |
| (Counsel for XYZ Trucking Co.) | Utility Commission |
| Room 117 | |
| North Office Building | |
| Harrisburg, Pa. 17120 | |
| Acceptance of service endorsed by the following: | |
| Hon. William Bradford (717) 787-3391 Attorney General of Pennsylvania | |
| John Doe, Esquire (215) 555-5678 | c/o Miss Mary Smith, |
| 123 East Chestnut Street | Secretary to the |
| Philadelphia, Pa. 19175 | Attorney General |
| (Counsel for ABC Forwarding Co.) | 16th Floor Strawberry Square |
| Harrisburg, Pa. 17120 | |
| Dated: May 26, 1975 | |
| (S)
| |
| John Jones, Esquire (Attorney Registration No. 00000) 123 East Chestnut Street Philadelphia, Pa. 19175 | |
| Of counsel for ABC Railway Corporation | |
Note
Under 18 Pa.C.S. § 4904 (unsworn falsification to authorities) a knowingly false proof of service constitutes a misdemeanor of the second degree. Where a large number of persons are named in the proof of service the appellate prothonotary and other parties may cut up a photocopy of the proof of service to form mailing labels for docketing notices, mailing briefs, etc., without the need to retype the list.
The provisions of this Rule 122 amended February 27, 1980, 10 Pa.B. 1038, effective as set forth at 10 Pa.B. 1038; amended April 20, 1990, effective May 12, 1990, 20 Pa.B. 2515. Immediately preceding text appears at serial pages (50273) to (50274).
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