Fillable Proof Of Service Certified Mail Form Rf-111 Arizona printable pdf download

Arizona Department of Real Estate (ADRE)

DOUGLAS A. DUCEY

Real Estate Recovery Fund

GOVERNOR

Proof of Service – Certified Mail (RF-111)

JUDY LOWE

2910 N. 44

STREET STE-100, PHOENIX, AZ 85018

COMMISSIONER

The undersigned Applicant states the following:

1. Applicant is a citizen of the United States over the age of 18 years, and is competent to testify to the facts stated herein, which

describe the circumstances warranting service by certified mail on the following Judgment

Debtor:

_________________________________________________________________________________________

2. Judgment Debtor currently holds a license issued by the Department of Real Estate.

3. Following is the Judgment Debtor’s current address of record with the Department:

Address: _____________________________________________________________________________________________

_____________________________________________________________________________________________

City, State, ZIP: ____________________________________________________________________________________________

4. Pursuant to A.R.S. §32-2188.01(B), Applicant served the Judgment Debtor with the Notice to Judgment Debtor (Form RF-109) and

the Application for Payment from the Recovery Fund (Form RF-107), with all of the attachments identified in the Application, by

placing true copies in a sealed envelope addressed to the address identified in No. 3 above, with postage thereon fully prepaid,

certified and return receipt requested, in the U.S. Postal Service mail as follows:

Location of Post Office: City ________________________ State __________________ Date: _________, 20____.

5. Attached are copies of the following (check all that apply):

Green card (return receipt) returned by the post office indicating when and to whom the envelope was delivered

The envelope returned undeliverable with the following explanation (check all that apply):

Moved - Left No Forwarding Address

Unclaimed

Other:

Check one: The original

OR a copy

of the envelope that was returned by the Post Office is attached.

CERTIFICATION BY APPLICANT

I declare that I have prepared and read the foregoing Proof of Service and know of my own knowledge that the facts, circumstances

and statements made therein are true and correct.

EXECUTED on __________________, 20____,

Signature:

at ____________________________, Arizona.

X ______________________________________

Applicant’s Name: __________________________________________

Address: _______________________________________________

City, State, ZIP: ________________________________________

Phone Number(s): ___________________________________ Email: ______________________

NOTICE TO APPLICANT:

· Your Application is not substantially complete without proof of service on each Judgment Debtor against whom you are making a

claim. Only use this method of service if both of the following conditions apply:

(1) The Judgment Debtor does not currently hold a license issued by the Department.

(2) After reasonable diligence, you cannot affect personal service on the Judgment Debtor.

· When you receive the Publisher’s Certificate, complete this form and attach the original certificate and process server’s Affidavit(s)

referenced in No. 4 above. Mail or submit via

Message Center

completed form and all attachments to:

Recovery Fund Administrator

Arizona Department of Real Estate

2910 N. 44th Street, Suite 100

Phoenix, AZ 85018

For Department Use Only

RF-111 Rev. 08/16

RF File No.

Proof Of Service Certified Mail Form Rf-111 Arizona

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