CLEAR FORM
Case Name: _______________________________________ CERTIFICATE OF SERVICE
Case No. ________________
I, _____________________________ (name), certify that I am, and at all times during the service of process was, not less than 18 years of age and not a party to the matter concerning which service of process was made. I further certify that the service of this summons and a copy of the complaint was made _________________________(date) by: ____ Electronically: Notice of Electronic Filing ____ Mail service: Regular, first class United States mail, postage fully pre-paid, addressed to:
____ Personal Service: By leaving the process with defendant or with an officer or agent of defendant at:
____ Residence Service: By leaving the process with the following adult at:
____ Certified Mail Service on an Insured Depository Institution: By sending the process by certified mail addressed to the following officer of the defendant at:
____ Publication: The defendant was served as follows: (Describe briefly)
____ State Law: The defendant was served pursuant to the laws of the State of ____________, as follows: (Describe briefly)
Under penalty of perjury, I declare that the foregoing is true and correct. ____________________________________ Date ____________________________________ Signature
Print Name: _________________________________________ Business Address: ____________________________________ City: ______________________ State _________ Zip _______