Proof of Service by Mail

Case Name:
Case Number:
Court Name:

I am over the age of 18 and not a party to this case.
My name is:
My address is:
Date Mailed:
City and State Mailed From:

Documents Served (list):
Name and Address of Person Served:

I placed a copy of the above document(s) in a sealed envelope, with postage fully prepaid, and deposited the envelope with the United States Postal Service.

Date:
Signature:
Print Name: