This form and any additional pages must be served on all unrepresented parties and counsel of record. Type of Confidential Document.These are the official forms for use in Family Court proceedings. You will need one copy of the civil complaint with original signature for the magisterial district judge. Form I-19 Affidavit of Confidential Address. Patient has continually signed out of hospital AMA. Patient has continually refused prescribed treatment (i.e. medication). The Contractor agrees to indemnify, protect, defend and hold harmless the. Reviewed a sample of County Disclosure of Interest Statements and Pennsylvania. Statement of Financial Interests forms for completeness and timely filing.