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WEST VIRGINIA RETURN OF SERVICE , an individual (West Virginia Supreme Court of Appeals)

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SCA-FC-132: West Virginia Return of Service
Review Date: 10/2014; Revision Date: 10/2015 WVSCA Approved: 2/9/2016
Page 1 of 1
WEST VIRGINIA RETURN OF SERVICE
, an individual over the age of 18 years, who is
, personally servednot a party to Civil Action No.
at the following address:
with a copy of the following:
on the day of , 20 , at
:
a.m./
p.m.
(Please print your name on this line so that it can be easily read.)
I,
Signature
STATE OF WEST VIRGINIA
County of ____________________________,
to-wit:
This Return of Service was sworn to or affirmed before me on this _______ day of
______________________, 20_____.
________________________________________
Notary Public / Other Official
My commission expires: ___________________________________.
Address of Server:
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WEST VIRGINIA RETURN OF SERVICE , an individual (West Virginia Supreme Court of Appeals)

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Completed 18 October 2021

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