Affidavit Of Service Form - Superior Court Of New Jersey
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Plaintiff
Superior Court of New Jersey
vs.
Venue
Defendant
Docket Number
:
(Name & Address)
Person to be served
AFFIDAVIT OF SERVICE
(For Use by Private Service)
Cost of Service pursuant to R. 4:4-3(c)
Attorney:
$
Papers Served:
Service Data:
_____
Served Successfully
Not Served
Date:
Time:
______________
Attempts: ___________
Delivered a copy to him / her personally
Name of Person Served and relationship / title:
Left a copy with a competent household
member over 14 years of age residing
therein
(indicate name & relationship at right)
Left a copy with a person authorized to
accept service, e.g., managing agent
,
registered agent, etc.
(Indicate name & official title at right)
Description of Person Accepting Service:
Sex: ____
Age: ____
Height:
Weight: ____ Skin Color:
Hair Color:
Unserved:
( ) Defendant is unknown at the address furnished by the attorney
( ) All reasonable inquiries suggest defendant moved to an undetermined address
( ) No such street in municipality
( ) No response on:
Date
Time
Date
Time
( ) Other:____________________________ Comments or Remarks_______________________
Server Data:
I, <Name of Server>, was at the time of service a
Subscribed and Sworn to me this
competent adult not having a direct interest in the
____ day of __________________
litigation. I declare under penalty of perjury that
the foregoing is true and correct.
Notary Signature
Signature of Process Server
Date
Name of Notary / commission expiration
<Insert Private Server’s name, address and telephone number.>
Affidavit of Service (9/30/02)
Revised 9/30/2002, CN 10516-English
page 1 of 1
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