Form 3 - Acknowledgement Of Service
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1FORM 3
IN THE PROV
INCIAL COURT OF NEWFOUNDLAND AND
LABRADOR
COURT CENTRE: _____________________________
Court File No. _________
______ ______
_
BETW
EE
N: ________________________________________
APPLICANT
AND:
_____________________
___________________
RESPONDENT
ACKNOWLEDGEMENT OF SERVICE
I am _____________________________________, the Applicant/Respondent named in the ___________ (specify
document being served). I have this _____ day of ________________________, 20____, at ________________
__
in the Province of ______________________,
recei
ved a copy of the within ______________ (specify document
being served). My mailing address for further service of documents and my telephone number(s) are as follows:
Telephone(s): __________________________
Address: __________________________________________
_
_____________________________________
__________________________________________________
______________________________________
____________
_
____________________________________
____________________________________
Witness
Signature of Applicant/Respondent
*
The person who serves an application or other document shall request at the time of service that the Applicant/Responden
t
complete and sign this Acknowledgement of Service at that time and the server shall sign as a witness.
AFFIDAVIT OF SERVICE
I, ____________________________________, of ___________________________________________ in the
Province of ____________________________________, make oath and say as follows:
1. That I did personally serve the above named Applicant/Respondent with the attached _________________ (specify
document served) on ____________, t
he _______ day of _________________________, 20____, by delivering a
tr
ue copy of same to the Applicant/Respondent at _____________________________________in the Province of
______________________________.
2. That at the time of service I requested the Applicant/Respondent to complete and sign the Acknowledgement of
Service and my request was accepted/declined.
3. My knowledge of the identity of the Applicant/Responden
t is as follows:
(a) The Applicant/Respondent is personally known to me.
(b) Other ____________________________________________________________________________
____________________________________________________________________________________.
SWORN TO OR AFFIRMED AT:
__________________________________ in the
Province of _____________________________
this________ day of _______________, 20____.
_____________________________________
Sig
nature of person who served this document
_____________________________________
Commissioner of Oaths/Justice of the Peace
* To be completed by the person who served the document on
the Applicant/Respondent and signed in the presence of a person
authorized to take oaths.
FILED this _____ day of _________________, 20_____.
_
____________________________________
Court Clerk
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