Affidavit of Service (9/30/02)
Superior Court of New Jersey
Docket Number
Person to be served (Name & Address):
(For Use by Private Service)
Cost of Service pursuant to R. 4:4-3(c)
Papers Served:
Service Data:
Served Successfully _____ Not Served Date: Time:
Attempts: ___________
Delivered a copy to him / her personally
Left a copy with a competent household
member over 14 years of age residing
therein (indicate name & relationship at right)
Left a copy with a person authorized to
accept service, e.g., managing agent,
registered agent, etc.
(Indicate name & official title at right)
Name of Person Served and relationship / title:
Description of Person Accepting Service:
Sex: ____ Age: ____ Height: Weight: ____ Skin Color: Hair Color:
( ) Defendant is unknown at the address furnished by the attorney
( ) All reasonable inquiries suggest defendant moved to an undetermined address
( ) No such street in municipality
( ) No response on: Date Time
Date Time
( ) Other:____________________________ Comments or Remarks_______________________
Server Data:
Subscribed and Sworn to me this
____ day of __________________
Notary Signature
Name of Notary / commission expiration
I, <Name of Server>, was at the time of service a
competent adult not having a direct interest in the
litigation. I declare under penalty of perjury that
the foregoing is true and correct.
Signature of Process Server Date
<Insert Private Server’s name, address and telephone number.>
Clear form