CRIMINAL MOTION COURT 206 Criminal Justice Center 1301 Filbert Street Philadelphia, PA 19107
OFFICE USE ONLY
Listed for: Motion Court #: Room 504 Time: 9:00 AM
IN THE COURT OF COMMON PLEAS PHILADELPHIA COUNTY
Notice of Appeal from Summary Criminal Conviction
Name and Address of Defendant: Summary # Date of Sentence: Offenses of Which Convicted:
Issuing Authority: Hearing Judge: Sentence: Community Service: Yes Fine & Cost: $ No Amount Paid: $
Type or Amount of Bail Furnished to Issuing Authority, if any: Name and Address of Attorney for Defendant:
01-204