Free CCG 0060 12-7-00 - Illinois

Affidavit of Special Process Server

CCG N060-10M-2/24/05 (

)

IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS ______________________________________________ DEPARTMENT, ______________________________________ (County) (Municipal) (Division) (District)

No. ________________________________

AFFIDAVIT OF SPECIAL PROCESS SERVER ________________________________________________________________________________________________ being first duly sworn on oath deposes and says that s/he was appointed by the Court on ____________________________, ________ to serve process in the above mentioned cause. I. That s/he served the within summons and a copy of the complaint on the within named Defendant, _____________ __________________________________________________________________________________________________ by leaving a copy of each with the said Defendant personally on ___________________________________, ________. II. That s/he served the within summons and a copy of the complaint on the within named Defendant, ______________ __________________________________________________ by leaving a copy of each at his/her usual place of abode with _________________________________________ a person of the family of the age of 13 years or upwards and informed that person of the content thereof on _____________________________, ________, and that further s/he mailed a copy of each in a sealed envelope with postage prepaid addressed to the Defendant, __________________________ at his/her usual place of abode on _____________________________, ________. III. (a) That the sex, race and approximate age of the Defendant or other person with whom s/he left the summons are as follows: Sex _______________ Race ___________________________ Approximate Age ________ (b) That the place where (if possible in terms of an exact street address) and the date and time of the day when the summons was left with the Defendant or other person were as follows: Place ___________________________________________________________________________________________ Date _________________________, ________ Time of day __________________. m.

IV. That s/he was unable to serve the within named Defendant. ________________________________________________ Special Process Server Signature Signed and sworn before me on this __________________ day of _____________________________________, __________ __________________________________ Notary public DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS
ORIGINAL COURT FILE