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SUPERIOR COURT OF THE DISTRICT OF COLUMBIA FAMILY (Superior Court of DC)

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U.S.A. forms for Superior Court of DC

BROWSE SUPERIOR COURT OF DC (DC) FORMS

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D.C. Bar Pro Bono Center (revised 02/2019) Affidavit of Service by Certified Mail - Page 1 of 3
SUPERIOR COURT OF THE DISTRICT OF COLUMBIA
FAMILY COURT
Domestic Relations Branch
____________________________________
PRINT PLAINTIFF’S NAME
PLAINTIFF,
v.
____________________________________
PRINT DEFENDANT’S NAME
DEFENDANT.
__________ DRB __________
JUDGE: __________________
AFFIDAVIT OF SERVICE BY
CERTIFIED MAIL
I, _______________________________, am the PLAINTIFF
PRINT YOUR NAME DEFENDANT
OTHER _________________________________
RELATIONSHIP TO CASE
1. I certify that I served copies of the following paper(s) in this case:
The summons The following orders: ___________________________________
A copy of the complaint Other: _______________________________________________
A Notice of Motion Other: _______________________________________________
to the other party at ______________________________________, their: TEMPORARY RESIDENCE.
ADDRESS PERMANENT RESIDENCE.
OTHER: ____________________.
SPECIFY TYPE OF RESIDENCE
2. I received the return receipt (“green card”) from the U.S. Postal Service.
3. I reviewed the return receipt (“green card”), it was signed on _________ and I believe that (CHECK ONE):
it was signed by the other party: ______________________________________
NAME OF THE OTHER PARTY
it was signed by a person of suitable age and discretion who lives at the home of the other party. I
state the following about the person who signed the return receipt:
Their name is: ________________________.
Their approximate age is: _______________.
D.C. Bar Pro Bono Center (revised 02/2019) Affidavit of Service by Certified Mail - Page 2 of 3
Their relationship to the other party is:
Spouse/partner Family member (specify): _____________________
Roommate Other: _____________________________________
The reason why I believe this person lives at the above address is:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
I believe this person is of suitable age and discretion and will give the papers to the other party because:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
I declare under penalty of perjury that the foregoing is true and correct.
If this document is to be signed outside the geographic boundaries of the United States, Puerto
Rico, the United States Virgin Islands, and any territory or insular possession subject to the
jurisdiction of the United States, additional requirements must be met prior to signing. See SCR-
Dom. Rel. 2(c)(1)(B).
____________________________________
SIGN YOUR NAME
____________________________________
PRINT YOUR NAME
____________________________________
HOME ADDRESS 1
____________________________________
HOME ADDRESS 2
SUBSTITUTE ADDRESS: CHECK THIS BOX
IF YOU HAVE WRITTEN SOMEONE ELSE’S
ADDRESS BECAUSE YOU FEAR HARASSMENT
OR HARM.
____________________________________
DATE
____________________________________
PHONE NUMBER
____________________________________
EMAIL ADDRESS
D.C. Bar Pro Bono Center (revised 02/2019) Affidavit of Service by Certified Mail - Page 3 of 3
ATTACH THE RETURN RECEIPT (“GREEN CARD”) HERE
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SUPERIOR COURT OF THE DISTRICT OF COLUMBIA FAMILY (Superior Court of DC)

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Completed 19 January 2022

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