AFFIDAVIT OF SERVICE

County of [COUNTY]
State of [STATE]

1. SERVER. I, [SERVER NAME] (“Server”), declare under penalty of perjury that the following documents were delivered and served in the following manner:

2. DOCUMENTS. The documents served are described as: [DOCUMENT(S) NAME].

3. RECIPIENT. The above-mentioned documents were delivered to:

1. Defendant/Respondent: [RECIPIENT NAME] (“Recipient”)
2. Address/Location: [RECIPIENT ADDRESS]
3. Date: [MM/DD/YYYY] Time: [HH]:[MM] ☐ AM ☐ PM

4. DELIVERY. The Recipient received the documents by: (check all that apply)

☐ – Mail. The Server sent the documents by: (check all that apply)

☐ – Standard Mail
☐ – E-Mail
☐ – Certified Mail (with return receipt)
☐ – FedEx
☐ – UPS
☐ – Other: [OTHER MAILING METHOD]

☐ – Direct Service. The Server handed the documents to a person identified as the
      Recipient.
☐ – Delivery to Resident. The Server handed the documents to someone who
      identified as living at the residence and stated their name is: [COTENANT NAME].
☐ – Delivery to Co-worker. The Server handed the documents to someone who
      identified to be the Recipient’s co-worker and stated their name is:
      [COWORKER NAME].
☐ – Leaving at the Residence. The Server left the documents in the following area:
      [DELIVERY AREA].
☐ – Recipient Rejected Delivery. The Server delivered the documents to the Recipient
      in-person and did not accept delivery.
☐ – Other. [OTHER SERVICE METHOD].

5. VERIFICATION. I declare under penalty of perjury under the laws located in this [STATE] that the foregoing is true and correct.

Server’s Signature: _____________________________ Date: ______________
Print Name: [SERVER NAME]