RF-110 Rev. 03/18
Arizona Department of Real Estate (ADRE)
Real Estate Recovery Fund
www.azre.gov
Personal Service Affidavit (RF-110)
GOVERNOR
JUDY LOWE
COMMISSIONER
100 N. 15th Ave., Suite 201 PHOENIX, AZ 85007
RF File No.
T
he undersigned Applicant states the following:
1
. T
hat I am a private process server registered in __________________ County, Arizona, and that I received the Notice to
Judgment Creditor (Form RF-109) and the Application for Payment from the Real Estate Recovery Fund (Form RF-107), together
with all of the attachments,
f
rom __________________________________________________________ on ________________________________, 20____.
attempted to serve
2. That I personally served a copy of each document listed above as follows:
J
udgment Debtor’s Name: _____________________________________________________________________________
A
ddress (street/city/state):______________________________________________________________________________
D
ate(s) and Time(s): __________________________________________________________________________________
Place of Service: Residence Business (Provide Business Name) Other (Describe):
____
________________________________________________________________________________________________
3. � I
performed a search to locate Judgment Debtor, and made ________ attempts to serve the Judgment Debtor at the above address
but was never able to make contact with anyone or ascertain the current whereabouts of the Judgment Debtor.
_______ Miles @ ________ $__________.____ X ______________________________________________________
Affiant
_______ Miles @ ________ $__________.____ SUBSCRIBED AND SWORN to before me this
____
___ Miles @ ________ $__________.____ _______ day of ________________________________________, 20___.
Total Mileage: $__________.____ X ________________________________________________________
Notary Public
A
ttempted Service: $__________.____ My Commission expires: ___________________________________________
S
ervice: $__________.____ NAME, ADDRESS, PHONE NUMBER, & EMAIL OF PROCESS
SERVER:
Skip Trace: $__________.____
Other Services: ______________________
$__________.____
Affidavit/Notary Fee $__________.____
N
OTICE TO APPLICANT:
·
Y
our Application is not substantially complete without proof of service on each Judgment Debtor against whom you are making
a
cl
aim. Only use this method of service if both of the following conditions apply:
(1) The Judgment Debtor does not currently hold a license issued by the Department.
(2)
A
fter reasonable diligence, you cannot affect personal service on the Judgment Debtor.
·
W
hen you receive the Publisher’s Certificate, complete this form and attach the original certificate and process server’s Affidavit(s)
referenced in No. 4 above. Mail or submit via Message Center
completed form and all attachments to:
Recovery Fund Administrator
Arizona Department of Real Estate
100 N. 15th Ave, Suite 201
Phoenix, AZ 85007
Your Application will not be treated as substantially complete without Proof of Service on each Judgment Debtor against
whom you are making a claim.
