Statement Of Service Form Page 2
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3Version 1-- Sample statement of service
On (date) December 15, 2010, I served (type of document) an unfair labor practice charge on (party
served) The City of Hometown by:
(Check the appropriate box(s) and write in the street address, email address, and/or fax number at
which service was completed)
☐ Hand delivery at ____________________
☒ Registered, certified, or regular mail to 123456 Main, Hometown, Michigan 48123_
☐ Private delivery service to______________________________________________
☐ Email to ______________________
☐ Fax to_____________________________
Mary Smith
Signature
Date December 16, 2010
Print Name Mary Smith
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Parent category: Legal