Proof of Personal Service Affidavit
Case Name:
Case Number:
1. Person Serving Documents
Name:
Address:
Telephone Number:
Relationship to parties:
2. Documents Served
3. Person Served
Name of party served:
4. Service Details
Date (MM/DD/YYYY):
Time:
Address where served:
5. Method of Service
6. Declaration
I declare under penalty of perjury under the laws of the State of
that the foregoing is true and correct.
Date:
Signature:
Printed Name: