RF-111 Rev. 03/18
Arizona Department of Real Estate (ADRE)
Real Estate Recovery Fund
www.azre.gov
Proof of Service – Certified Mail (RF-111)
GOVERNOR
JUDY LOWE
COMMISSIONER
100 N. 15th Ave., Suite 201 Phoenix AZ 85007
RF File No.
T
he undersigned Applicant states the following:
1.
A
pplicant is a citizen of the United States over the age of 18 years, and is competent to testify to the facts stated herein, whic
h
d
escribe the circumstances warranting service by certified mail on the following Judgment
Debtor:
_________________________________________________________________________________________
2.
J
udgment Debtor currently holds a license issued by the Department of Real Estate.
3
. F
ollowing is the Judgment Debtor’s current address of record with the Department:
Address: _____________________________________________________________________________________________
____
_________________________________________________________________________________________
City, State, ZIP: ____________________________________________________________________________________________
4
. P
ursuant to A.R.S. §32-2188.01(B), Applicant served the Judgment Debtor with the Notice to Judgment Debtor (Form RF-109) an
d
t
he Application for Payment from the Recovery Fund (Form RF-107), with all of the attachments identified in the Application, by
placing true copies in a sealed envelope addressed to the address identified in No. 3 above, with postage thereon fully prepaid,
certified and return receipt requested, in the U.S. Postal Service mail as follows:
Location of Post Office: City ________________________ State __________________ Date: _________, 20____.
5. Attached are copies of the following (check all that apply):
Green card (return receipt) returned by the post office indicating when and to whom the envelope was delivered
The envelope returned undeliverable with the following explanation (check all that apply):
Moved - Left No Forwarding Address
Unclaimed
Other:
Check one: The original OR a copy of the envelope that was returned by the Post Office is attached.
CE
RTIFICATION BY APPLICANT
I declare that I have prepared and read the foregoing Proof of Service and know of my own knowledge that the facts, circumstances
and statements made therein are true and correct.
EXECUTED on __________________, 20____, Signature:
at ____________________________, Arizona. X ______________________________________
Applicant’s Name: __________________________________________
A
ddress: _______________________________________________
City, State, ZIP: ________________________________________
P
hone Number(s): ___________________________________ Email: ______________________
NOTICE TO APPLICANT:
· Your 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:
Arizona Department of Real Estate
Recovery Fund Administrator
100 N. 15th Ave., Suite 201
Phoenix, AZ 85007
