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CASE DATA

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I / We submit that the information provided above is true and accurate to the best of my / our knowledge. I / We acknowledge this file may be retained for three (3) years after my case is closed and consent to its destruction after that time.

I / We agree that by checking this box and providing my / our name(s) and the current date below, I / we acknowledge that the information provided on this form is to be treated as though it is an actual, physical legal document. By providing my / our name(s), I / we understand that I / we are signing this form, and that I / we are bound by any and all legal obligations that may entail.

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Achille, Ellermeyer, & Wallisch, Attorneys at Law
379 Main Street
Brookville, PA  15825

Phone: 814-849-6701
Toll Free: 1-800-498-2889
Fax: 814-849-2889

E-Mail: achille@palaw.org

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