Complete the entire form and check all that apply. This form and any additional pages must be served on all unrepresented parties and counsel of record.Form I-19 Affidavit of Confidential Address. The County Administrator issues a warrant authorizing a policeman or someone representing the County. The information contained in this Code is the framework for making business decisions that will ensure we are fulfilling our responsibilities with integrity. The Notice tells you about the ways UPMC may use and share your health information, as well as the legal duties we have about your health information. To file for custody, you must present the prepared legal paperwork and associated fees for filing with the: Department of Court Records First Floor Reviewed a sample of County Disclosure of Interest Statements and Pennsylvania. Statement of Financial Interests forms for completeness and timely filing. Each of the documents listed below inculde a blank form and the instructions to fill out that form.