Affidavit of Process Server
(NAME OF COURT)
VS
PLAINTIFF/PETITIONER DEFENDANT/RESPONDENT CASE NUMBER
I __________________________________, being first duly sworn, depose and say: that I am over the age of 18 years and
not a party to this action, and that within the boundaries of the state where service was effected, I was authorized by law to
perform said service.
Service: I served ________________________________________________________________________
NAME OF PERSON / ENTITY BEING SERVED
with (list documents)______________________________________________________________________
by leaving with _______________________________________________________________________ At
NAME RELATIONSHIP
□ Residence_____________________________________________________________
ADDRESS CITY / STATE
□ Business______________________________________________________________
ADDRESS CITY / STATE
On_________________________________________________AT_________________________________________
DATE TIME
□ Inquired if subject was a member of the U.S. Military and was informed they are not.
Thereafter copies of the documents were mailed by prepaid, first class mail on
DATE
from
CITY STATE ZIP
Manner of Service:
□ Personal: By personally delivering copies to the person being served.
□ Substituted at Residence: By leaving copies at the dwelling house or usual place of abode of the person being
served with a member of the household over the age of ________ and explaining the general nature of the papers.
□ Substituted at Business: By leaving, during office hours, copies at the office of the person/entity being served with
the person apparently in charge thereof.
□ Posting: By posting copies in a conspicuous manner to the front door of the person/entity being served.
Non-Service: After due search, careful inquiry and diligent attempts at the address(es) listed above, I have been
unable to effect process upon the person/entity being served because of the following reason(s):
□ Unknown at Address □ Moved, Left no Forwarding □ Service Cancelled by Litigant □ Unable to Serve in Timely Fashion
□ Address Does Not Exist □ Other________________________________________________________________________
Service Attempts: Service was attempted on: (1)_________________________ (2)________________________
DATE TIME DATE TIME
(3)____________________________ (4)___________________________ (5)____________________________
DATE TIME DATE TIME DATE TIME
Description:. Age_____Sex_____Race_____Height_______Weight______Hair_____Beard_____Glasses_____
SIGNATURE OF PROCESS SERVER
SUBSCRIBED AND SWORN to before me this ________day of _______________, 20___, by __________________,
Proved to me on the basis of satisfactory evidence to be the person(s) who appeared before me.
______________________________________
SIGNATURE OF NOTARY PUBLIC
NOTARY PUBLIC for the state of______________________
FORM 2 NATIONAL ASSOCIATION OF PROFESSIONAL PROCESS SERVERS
