UNITED STATES DISTRICT AND BANKRUPTCY COURTS
FOR THE DISTRICT OF COLUMBIA
____________________________________
Plaintiff(s)
Civil Action No. _______________
vs.
____________________________________
Defendant(s)
AFFIDAVIT OF MAILING
I, _________________________________________, hereby state that:
On the __________ day of ________________________, _______, I caused to be deposited in the
United States Mail a copy of the summons and complaint in the above captioned case, postage prepaid,
return receipt requested, restricted delivery, addressed to the following defendant:
I have received the receipt for the certified mail, No. ______________________________
(attached hereto), indicating that delivery of the summons and complaint was made upon said defendant
on the __________ day of ________________________, _______.
I declare under penalty of perjury that the foregoing is true and correct.
________________________ _________________________________
(Date) (Signature)
CO 249
Rev. 2/2010
