CO 249 Rev. 7/07
UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLUMBIA
____________________________________ Plaintiff(s) Civil Action No. _______________ vs.
____________________________________ Defendant(s)
AFFIDAVIT OF MAILING I, _________________________________________, hereby state that: On the __________ day of ________________________, _______, I caused to be deposited in the United States Mail a copy of the summons and complaint in the above captioned case, postage prepaid, return receipt requested, restricted delivery, addressed to the following defendant:
I have received the receipt for the certified mail, No. ______________________________ (attached hereto), indicating that delivery of the summons and complaint was made upon said defendant on the __________ day of ________________________, _______. I declare under penalty of perjury that the foregoing is true and correct.
________________________ (Date)
_________________________________ (Signature)