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

COOK FIRST ______________________________________________ DEPARTMENT, ______________________________________ (County) (Municipal) (Division) (District)

PRINT YOUR CASE NUMBER No. ________________________________

AFFIDAVIT OF SPECIAL PROCESS SERVER

PRINT NAME OF SPECIAL PROCESS SERVER ________________________________________________________________________________________________ being first PRINT DATE OF ORDER 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, _____________

PRINT NAME OF PERSON OR PARTY BEING SUED __________________________________________________________________________________________________ PRINT DATE SERVED 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, ______________

PRINT NAME OF PERSON OR PARTY BEING SUED __________________________________________________ by leaving a copy of each at his/her usual place of abode with

PRINT NAME OF PERSON SUMMONS GIVEN TO a person of the family of the age of 13 years or upwards and informed _________________________________________ PRINT DATE SUMMONS WAS SERVED 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, __________________________ OR PARTY BEING SUED
PRINT NAME OF PERSON

PRINT MAILING DATE 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
PRINT SEX PRINT RACE are as follows: Sex _______________ Race ___________________________ Approximate Age PRINT 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:

A S

P M
ORIGINAL COURT FILE

E L

PRINT COMPLETE ADDRESS OF PROPERTY WHERE SUMMONS WAS SERVED Place ___________________________________________________________________________________________
Date PRINT DATE SUMMONS WAS ________ _________________________, SERVED

PRINT TIME Time of day __________________. m. PLEASE SIGN YOUR NAME NOTE: SIGNATURE MUST BE WITNESSED BY A NOTARY ________________________________________________
Special Process Server Signature

IV. That s/he was unable to serve the within named Defendant.

Signed and sworn before me on this __________________ day of _____________________________________, __________

THIS SECTION TO BE COMPLETED BY A NOTARY__________________________________ Notary public PUBLIC
DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS