B250A - LF 7004 (12/09)
UNITED STATES BANKRUPTCY COURT
EASTERN DISTRICT OF WASHINGTON
In re
)
Bankruptcy Case No.
)
Debtor )
Adversary Proceeding No.
)
)
Plaintiff)
CERTIFICATE OF SERVICE
)
)
Defendant)
I, _____________________________(name), certify that service of this summons and a copy of the
complaint was made _______________________ (date), by:
M ail service: Regular, first class United States mail, postage fully pre-paid, addressed to:
Personal Service: By leaving the process with defendant or with an officer or agent of defendant at:
Residence Service: By leaving the process with the following adult at:
Certified M ail Service on an Insured Depository Institution: by sending the process by certified mail
addressed to the following office of the defendant at:
Publication: The defendant was served as follows: [Describe briefly]
State Law: The defendant was served pursuant to the laws of the State of ___________________, as
follows: [Describe briefly]
If service was made by personal service, by residence service, or pursuant to state law, I further certify that
I am, and at all times during the service of process was, not less than 18 years of age and not a party to the
matter concerning which service of process was made.
Under penalty of perjury, I declare that the foregoing is true and correct.
____________________________
DATE
SIGNATURE
Print Name:
____________________________________________
________________________________________
____
Business Address:
____________________________________________
____________________________________________