AFFIDAVIT OF SERVICE
County of __________________
State of __________________
Date: __________________, 20____
I. SERVER. I, __________________ (“Server”), declare under penalty of perjury that a
notice for eviction was delivered and served in the following manner:
II. RECIPIENT. The notice for eviction was delivered to:
a.) Defendant/Respondent: __________________ (“Recipient”)
b.) Address/Location: ____________________________________
c.) Date & Time: __________________, 20____ Time: ____:____ ☐ AM ☐ PM
III. DELIVERY. The Recipient received the eviction notice by: (check one)
☐ - Mail. The Server sent the eviction notice in the mail by: (check one)
☐ - Standard Mail
☐ - Certified Mail (with return receipt)
☐ - FedEx
☐ - UPS
☐ - Other
☐ - Direct Service. The Server handed the eviction notice to a person identified as
the Recipient.
☐ - Someone at the Residence. The Server handed the eviction notice to
someone who identified as living at the residence and stated their name is:
__________________.
☐ - Someone at the Workplace. The Server handed the eviction notice to
someone who identified to be the Recipient’s co-worker and stated their name is:
__________________.
☐ - Leaving at the Residence. The Server left the eviction notice in the following
area: __________________.
☐ - Recipient Rejected Delivery. The Server delivered the eviction notice to the
Recipient in-person and did not accept delivery.
☐ - Other. __________________.
IV. VERIFICATION. I declare under penalty of perjury under the laws located in this State
that the foregoing is true and correct.
Server Signature: ________________________ Date: ______________
Print Name: ________________________