Sample Affidavit Of Service
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1AFFIDAVIT OF SERVICE
OMB Case No:_______________________
I, ______________________________________of the________________________________________________am a
(full name)
(city, town and county, region)
__________________________________________________________________________________.
(your role, if any, e.g. party, solicitor, representative, officer, member or employee of a party, etc.)
MAKE OATH AND SAY (or AFFIRM AND SAY) THAT:
Notice of [written] hearing of this matter, starting on __________________________________________and ending on
(hearing date, day, month, year)
______________________________ at _____________________________________________________was given by:
(day, month, year)
(place, address)
Check the correct one(s) and fill in necessary info.
1.
Publication in the _________________________________________________on _________________________.
(name of publication(s) )
(day, month, year)
A copy of the published notice is enclosed as Attachment # __________ .
2.
Delivering notice by prepaid registered (certified) mail, prepaid courier, or fax on ____________________
to __________________________________________________________.
(day, month, year)
(name of person, or if more than 2, refer to a list attached).
The list of persons to whom such notice was given and is enclosed to this Affidavit as Attachment #
_______________
3.
Posting copies of notice in public places in and around the municipality on ____________________________ to
__________________________________________________________.
(day, month, year)
(Place where notice was posted)
See the form attached for the names of the places where the notice was posted as Attachment #
_______________
4.
Any other means of service, including personal service, as may have been directed by the Board. Service of notice of
the hearing in this matter is in accordance with the instructions given by the Board in its letter dated,
____________________________.
(day, month, year)
Please ensure that notice has been given to: present parties, any appellant, objector and/or person who requested, in
writing, that he/she receive notice (as well as any persons within an area defined by the Board in its instructions for
service as being entitled to notice).
Fill out below if you are the person swearing to this affidavit.
I, in good faith and in support of______________________________________________ have sworn to this affidavit.
(the matter and/or legislation)
Sworn before me in the ____________________________________________on _________________.
(city/town and region/municipality/county)
(day, month, year)
________________________________________________________________
Signature of Person affirming Affidavit
________________________________________________________________
Commissioner for Taking Affidavits (or as may be)
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