1. (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.

2. (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 proof of service shall also show the telephone number, the party represented, and, where applicable, an e-mail or facsimile address. The name, address and telephone number of the serving party shall be similarly set forth, followed by the attorney’s registration number. 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:

   Name Telephone number
   Mailing address
   (Party represented)

   Acceptance of service endorsed by the following:

   Name, Telephone number
   Mailing address
   (Party represented)

   Service in person as follows:

   Name, Telephone number
   Street address
   Mailing address (if different)
   (Party represented)

   Service by commercial carrier as follows:

   Name of commercial carrier
   Addressee’s name, Telephone number
   Street address
   Mailing address (if different)
   (Party represented)

   Service by e-mail at following:

   E-mail address, with agreement of:
   Name, Telephone number
   Mailing address
   (Party represented)

   Service by facsimile at following:

   Fax number with the agreement of:
   Name, Telephone number
   Mailing address
   (Party represented)

   Date:

3. (S) Name, Telephone number
   (Attorney Registration No. 00000)
   Mailing address
   (Party represented)

   Official Note

   Under 18 Pa.C.S. § 4904 (unsworn falsification to authorities) a knowingly false proof of service constitutes a misdemeanor of the second degree.

Source

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; amended September 10, 2008, effective December 1, 2008, 38 Pa.B. 5257. Immediately preceding text appears at serial pages (361136) and (392563).