AFFIDAVIT OF SERVICE
(Hand Delivery/Private Process)
(Md. Rule 2-121)
NOTE: This form provides proof to the court that copies of documents filed in the above case by one
party have been provided to the other party. Complete this form if one of the individuals listed above has
asked you to hand deliver, or serve, documents to the other person in this case. Deliver, or serve, the
ORIGINAL court-issued summons and the document(s) to the person indicated. Attach a copy of the
summons to this notice before submitting this notice to the court.
I certify that I served . I served them at ☐ a.m. ☐ p.m.
on
at . I served them with a copy of the
documents checked below, which were previously filed with the court.
Check all that apply:
☐ Writ of Summons
☐ Complaint/Petition/Motion
☐ Domestic Case Information Report (form CC-DCM-001)
☐ Financial Statement
☐ Show Cause Order and Petiti
on
☐
Other (list of all other documents served):
I
completed the delivery, or service, in the following manner (select one):
☐ I personally handed the documents to the ☐ plaintiff ☐ defendant, whose name i
s
.
☐ I left the papers wit
h ,
who lives at the above-listed
address and is of suitable age and discretion and whose relationship to the person served is
.
The above-listed address is the ☐ plaintiff’s ☐ defendant’s residence or usual place of abode.
Description of person served: Race Sex Height Weight Age
I certify that I am at least 18 years old and I am NOT the plaintiff or the defendant.
I solemnly affirm under the penalties of perjury that the contents of this document are true to the best of
my knowledge, information, and belief.
CC
-DR-055 (Rev. 04/2021)
Issue date of the summons for the complaint/petition/motion listed below.
Name of complaint/petition/motion
CIRCUIT COURT FOR , MARYLAND
