Fillable In 1a, enter the name, mailing address, and (Microsoft)

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In 1a, enter the name, mailing address, and (Microsoft)

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In 1a, enter the name,
mailing address, and
email address of the
party or lawyer to
whom you sent the
document.
Enter the Case Number given by the Appellate Court Clerk: _________________________________
ADDITIONAL PROOF OF SERVICE
I sent this document:
a.
To:
Name:
First
Address:
Street, Apt #
Email address:
Middle
City
Last
State
ZIP
In 1b, check the box to
show how you are
sending the document.
CAUTION: If you and
the person you are
sending the document
to have an email
address, you must use
one of the first two
options. Otherwise, you
may use one of the
other options.
b.
By:
An approved electronic filing service provider (EFSP)
Email (not through an EFSP)
Only use one of the methods below if you do not have an email address, or the person you are
sending the document to does not have an email address.
Personal hand delivery to:
The party
The party’s family member who is 13 or older, at the party’s residence
The party’s lawyer
The party’s lawyer’s office
Mail or third-party carrier
In c, fill in the date and
time that you sent the
document.
c.
On:
At:
Date
Time
a.m.
p.m.
NAA-APS 2804.3
Page 1 of 1
(07/21)
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In 1a, enter the name, mailing address, and (Microsoft)

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Completed 1 July 2022

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