Senate Bill 1333 Printer's Number 1929

PENNSYLVANIA, October 3 - perjury that:

1. I am the owner of the dwelling or the authorized agent of

the owner of the dwelling.

2. The real property is a dwelling.

3. An unauthorized individual has unlawfully entered or

remained in the dwelling.

4. The unauthorized individual is not a tenant, a holdover

tenant or an immediate family member of the owner, and any lease

that may be produced by the unauthorized individual is

fraudulent.

5. The unauthorized individual does not have an ownership

interest in the property and is not listed on the title to the

property unless the individual has engaged in title fraud.

6. There is no litigation related to the dwelling pending

between the owner, or his or her agent, and any unauthorized

individual.

7. Notice was provided by hand delivery to the unauthorized

individual occupying the dwelling or by posting notice on the

front door or entrance of the dwelling, and evidence of the

notice, including the date and time of delivery, is attached.

8. I understand that an individual removed from the property

pursuant to this affidavit may bring a cause of action against

me for any false statements made in this affidavit, or for

wrongfully using this procedure, and that, as a result of the

action, I may be held liable for actual damages, penalties,

costs, and reasonable attorney fees.

9. I am requesting law enforcement to remove, as soon as

possible, the unauthorized individual from the dwelling.

10. A copy of my valid government-issued identification is

attached, or I am an agent of the property owner, and documents

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