Forms & Documents Page ContentCTRL + F to search for forms and documents on this page Area Agency on Aging 2016-2020 Four Year PlanAPPRISE BrochureGet Ready for EnrollmentHealth Savings AccountsHow Much Home Health Care Can I Get?Key Points about Medicare EnrollmentLebanon County Annual Enrollment EventMedicare Annual Enrollment: 5 Tips to Survive the SeasonMid-Year Formulary ChangesNon-Medical Home Care / Home Health / Hospice AgenciesNursing, Residential & Retirement HomesPA Department of Aging Waiver Fact SheetPCSP BrochurePennsylvania Emergency Preparedness GuidePersonal Care HomesPrograms that Could Help Save Money on Your Monthly PremiumsRespite Care FacilitiesTransitions: Human Services GuideVaccines: What Medicare Pays ForWhat to Bring Checklist Assessment Office Appeal Rules & RegulationsBoard of Assessment AppealClean and Green ActClean and Green ApplicationCover Letter for UPI VerificationFormal Appeal Withdrawal FormHomestead ApplicationIntent to Appeal FormRules for Verification of UPI NumbersUnderstanding the Clean and Green Program (Hidden) Children and Youth Services Clerk of Courts Nunc Pro Tunc Petition and Order.pdfNunc Pro Tunc Instructions.pdfSummary Appeal IFP Order And Motion.pdfClerk of Courts Fee Schedule 2019.pdfApplication Appeal from Summary Criminal ConvictionClerk of Courts Fee ScheduleClerk of Courts SubpoenaExpungement Procedure- CRIMINALIFP Summary Conviction OrderNotice of Appeal from Summary Criminal ConvictionPost Sentence Extension OrderPost Sentence Motion to Continue ExtensionPost Sentence Scheduling OrderPraecipe for Entry of AppearanceRequest for Delay of Suspension, Revocation, or Disqualification FormSAMPLE - Notice of Appeal from Summary Criminal Conviction Commission for Women Sponsorship Opportunities 2018.pdf2019 HOF Nomination form.pdf2017 Hall of FameBoard Members ListingBylawsVision and Mission StatementWomen's Groups in Lebanon County Commissioners' Office Thursdays 9-17-2020 Agenda.pdf2015 Budget2016 Budget SummaryMonument Park Public Events Application/Questionnaire Commission on Drug and Alcohol Abuse Lebanon County Comission on Drug and Alcohol Abuse - 2014-2015 Annual Report Community Action Partnership PHFA CARES RRP COVID-19 Rent Relief ApplicationShort-Term Rental and Shelter Assistance Application (Hidden) Conservation District (Hidden) Controller's Office (Hidden) Cooperative Extension (Hidden) Coroner's Office Court System Waiver of Arraignment.pdf2017 Court Calendar2019 Court Calendar2020 Court CalendarAcceptance of ServiceADA Policy/Forms for Lebanon County CourtsAffidavit of ConsentAffidavit of Nonmilitary ServiceAffidavit of ServiceAffidavit under Section 3301(d) & Certificate of ServiceAttorney ListCertificate of Trial Readiness FormCivil and Family Interpreter Request FormCivil Cover SheetCivil Division RulesComplaint under Section 3301(c) or (d) of Divorce CodeComplaint with Count 1 - Alimony Pendente LiteConfidential Information FormCriminal Division RulesCriminal Interpreter Request FormCriminal Record / Abuse History VerificationCriminal Scheduling FormCustody ComplaintCustody HandbookDivorce DecreeDivorce HandbookFamily Division RulesGuilt Plea ColloquyIn Forma Pauperis Petition - FormsIn Forma Pauperis Petition - InstructionsJuror Questionnaire - Civil CourtJuror Questionnaire - Criminal CourtJuror Service ReviewJury Summons QuestionnaireLanguage Access PlanLanguage Services ComplaintMotion for Appointment of MasterMunicipal Building Parking MapNew Local Rule 507Nolo Contendere PleaNotice of Intention to Request Decree under Section 3301(d)Notice of Proposed Relocation / Counter-Affidavit Regarding RelocationOrder of Appointment of ConciliatorOrphans' Court RulesParenting Plan FormParking MapPetition for ContemptPetition for ModificationPost Sentence ColloquyPraecipe to Transmit RecordRedistricting Plan for Lebanon County Magisterial District JudgesRule 600 Continuance FormSelf Represented Litigants HandbookService Document by Accepting ServiceService Document by Certified MailService Document by Personal ServiceService Form for Praecipe to Transmit RecordSpanish Form: Guilty Plea ColloquySpanish Form: Nolo Contendere PleaSpanish Form: Rule 600 ContinuanceSpanish Form: Waiver of ArraignmentSpecialty Court ApplicationTranscript Request FormWaiver of Jury TrialWaivers of Notice of Intention to Request Decree Criminal Justice Advisory Board CJAB Letter for IP Grant 2016-2018Offender Reentry Plan District Attorney ARD APPLICATION 2-21-19.pdfARD APPLICATION Spanish 4-23-19.pdfBad Check FAQPrecious Metals Unit Domestic Relations Policy for Submitting Medical Bills.pdfConfidential Information Form.pdfIN-005C - Complaint to Establish Paternity and for Genetic Testing -Non-IV-D.pdfAddress-Employer Change FormForm to Submit Medical Bills for CollectionInformation to Bring with You when Filing for SupportIntake QuestionnaireIntake Questionnaire (Spanish)Payment CouponPhysician's Information RequestPolicies & ProceduresPolicies & Procedures (Spanish)Policies for Submitting Medical Bills (Hidden) Emergency Management Agency Geographical Information Systems 2008/2005 Color Imagery RequestBasic County MapContour Data RequestCountywide Landbase Data RequestData DisclaimerDistribution PolicyE911 Addressing GuideLebanon County Scenic Bicycle RidesMunicipality Landbase Data Request Human Resources County of Lebanon ApplicationCounty of Lebanon ApplicationEEOP Short FormEmployee HandbookEqual Employment Opportunity Policy MH/ID/EI Program Lebanon County - FY 18-19 Human Services Plan - May 18.pdfNo Wrong Door - 2019Not the Answer Flyer w/ Tear OffsTake Your Friend by the Hand Flyer w/ Tear Offs Planning Department 2000 Census Fact Sheets by Municipality2010 Census Fact Sheets by Municipality2017 Public Officials DirectoryApproved List of Pumper/HaulerBuilding Code InfoConstruction Code Permit ApplicationEvaluation of Solids/Scum in Treatment Tank FormFrequently Asked QuestionsGeneral Building Code InformationGeneral Sewage Enforcement InformationGeneral Sewage Management InformationHow to Qualify for an Exemption from the Current Pumping CycleLCPD Enforcement JurisdictionsLSCLW Strategic PlanMaintenance Agreement for Holding Tank FormMaintenance Agreement for Temporary Holding Tank FormOn-Lot Sewage Disposal System Complaint FormResidential Permit Fee WorksheetSewage Management Exemption Application FormSmall Municipal Separate Storm Sewer Systems (MS4s)State, County & Census Tract NumbersStorm Water Management Ordinance (40MB)Subdivision and Land Development Ordinance (36.2MB)Subdivision ProcedureUCC Permit ApplicationZoning Enforcement Program To find more Planning Department forms & documents, click on the following page links: Comprehensive Plan Metropolitan Planning Organization Prison System Inmate HandbookMoney and Clothing Policy Probation Services Collections in the Courts.pdfAbility to Pay Evaluation - EnglishAbility to Pay Evaluation - SpanishAdult General Rules of SupervisionAdult Travel PassePay Brochure and User GuideJuvenile Community Service LogJuvenile General Rules of SupervisionLebanon County Probation Services Internship Program Prothonotary's Office praecipe for entry of appearance.pdfmdjappeal.pdfFee schedule - 2019 2020 2021.pdfFAMILY FEE - 2019 2020 2021.pdfMotion to Release Escrowed Funds.pdfPraecipe for Reference to Arbitrators and Waiver with Order.pdf236 NoticeAdministrative Order for Custody Conciliator Fee ChangeArbitration AwardBoard of Assessment Appeal FormCivil Cover SheetDriver's License Suspension Appeal and OrderMDJ AppealMotion and Order for Appointment of MasterNotice of Appeal from Award of Board of ArbitratorsNotice of Election to Retake Prior Name: After Divorce ComplaintNotice of Election to Retake Prior Name: After Final DecreeOrder for Appointment of ConciliatorPassport Application Petition and Order to Revoke and SubstitutePower of Attorney to SatisfyPraecipe and Writ for PossessionPraecipe and Writ of Execution (w/ attachment): Money Judgment w/ NoticesPraecipe and Writ of Execution (w/o attachment): Money Judgment w/ NoticesPraecipe and Writ of Execution: Mortgage ForeclosurePraecipe and Writ of RevivalPraecipe and Writ of SummonsPraecipe and Writ to Join Additional DefendantsPraecipe for DispositionPraecipe for Entry of AppearancePraecipe for HearingPraecipe for Motor Vehicle Judgment and CertificationPraecipe to Settle, Discontinue, and SatisfyRequest for JudgmentSheriff's Service FormStatement of Intention to Proceed: Civil DivisionStatement of Intention to Proceed: Family DivisionSubpoena to Attend and TestifySubpoena to Produce DocumentsTranscript Request (Hidden) Public Defender Purchasing Department Request for Bids for Printing Services Recorder of Deeds Fee Schedule 2017.pdfFEE SCHEDULE FIRST PAGE 2017.pdfE-Recording VendorsUPI Ordinance Register of Wills RegofWillsFeeSchedule2019.pdfMarriage Requirements.pdfRequisitos para Licencia de Matrimonio.pdfCovid Requirements FOR ML.pdf2014 Fee ScheduleOrphans' Court Rules (Hidden) Renova Center Sheriff's Office February 12, 2019 - Sale List.pdfBidding Information for Sheriff's SaleConditions of SaleFee ScheduleFinal ListLicense to Carry Firearms: ApplicationLicense to Carry Firearms: InstructionsSheriff's Service Form (Hidden) Tax Claim Bureau Treasurer's Office Dog License: Lifetime FormDog License: Permanent ID Verification FormHotel Occupancy TaxHotel Tax: Monthly Tax Exemption FormHotel Tax: Registration FormHunting and Fishing LicensesReal Estate Tax Payment Instructions Veterans Affairs Burial Records A-BBurial Records C-EBurial Records F-GBurial Records H-JBurial Records K-LBurial Records Master List (51.5MB)Burial Records M-OBurial Records P-RBurial Records S-WBurial Records X-ZInterred Veterans for the CountyInterred: Annville TownshipInterred: Bethel TownshipInterred: City of LebanonInterred: Cornwall BoroughInterred: East Hanover TownshipInterred: Jackson TownshipInterred: Jonestown BoroughInterred: Millcreek TownshipInterred: Myerstown BoroughInterred: North Annville Township 1Interred: North Annville Township 2Interred: North Cornwall TownshipInterred: North Lebanon Township 1Interred: North Lebanon Township 2Interred: North Londonderry TownshipInterred: Palmyra BoroughInterred: Richland BoroughInterred: South Annville TownshipInterred: South Lebanon TownshipInterred: South Londonderry TownshipInterred: Swatara TownshipInterred: Union TownshipInterred: West Cornwall TownshipInterred:Heidelberg TownshipNumber of Interred by Municipality Voter Registration Office UMOVA NOTICE General Election 11-06-18.pdfVoting System Demonstration.pdf2019 Campaign Finance Reporting Dates.pdf2019 Primary Election - Guide for Running for Local Office.pdf2019 Municipal Primary - Offices on the Ballot.pdf2019 Proposed Polling Place Addresses.pdfRedistricting Notice.pdfRedistricting Proposal Notice 2-11-19.pdf2019 UMOVA NOTICE Primary Election.pdf2019 Primary Election - Casting of Lots Results.pdf2019 Municipal Primary - Candidates List Ballot Order.pdfCandidates List - 2019 Primary Ballot Order.xlsx2019 Primary Election - Poll Worker Step by Step Guide.pdf2019 Poll Worker Fact Sheet.pdf2019 Polling Place Addresses.xlsx2019 Polling Place Addresses.pdfPrimary Sample Ballots.zip2019 Primary Election - Notice of Municipal Primary Election.pdf2019 Primary Municipal Election - Official Write-In Results (10 votes).pdfCandidates List - 2019 Municipal.xlsx2019 Municipal Election - Unofficial Candidates Listing.pdfVoter_Registration_Application_English.pdf2018_PA_Statewide_RemedialCongressionalDistricts.png2020 Polling Place Addresses.xlsx2020 Important Dates_FINAL.pdfAbsentee_Ballot_Application.pdfPADOS_MailInApplication.pdf2020 UMOVA NOTICE Primary General Election 4-28-20.pdf2020 Primary General Election Public Notice 04-28-20.pdfVoter_Registration_Application_Spanish.pdf11-05-19 Municipal Election Sample Paper Ballots11-5-19 Municipal Election Accessible Ballots2018 UMOVA Primary Election2019 Important Election Dates2019 Municipal Election - Write In Votes2019 UMOVA Notice - Municipal Election 2020 General Election Sample Ballots2020 General Primary - Casting of Lots2020 Notice of General Primary Election 2020 Polling Place Locations2020 Primary Election - Candidate List2020 Primary Election - Proposed Polling Place changes2020 Primary Election - Sample Ballots2020 Primary Election Polling Place Locations2020 Special Election - Paper Ballot2020 Special Election - Paper Ballot All Precincts2020 Special Election Public Notice2020 UMOVA Notice General Election 11-03-202020 UMOVA NOTICE Special Election Absentee Ballot ApplicationApplication for Alternative Ballot under the Voting Accessibility for the Elderly and Handicapped ActCampaign Finance Report - Form 502 ($250 and over)Candidate List - 2019 PrimaryCandidate List - 2019 Primary ElectionFormulario de Inscripción del VotanteFrequently Asked Questions about Mail-In BallotsMail-In Perm Status Cancellation FormRepublican County Commitee Write-In WinnersRepublican County Committee - Casting of Lots for tiesSouth Annville Township Referendum - English StatementVoter Registration FormVoting by Absentee or Mail-In Ballot (Hidden) Weights and Measures