Certificate Of Service
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1CLEAR FORM
Case Name: _______________________________________
Case No. ________________
CERTIFICATE OF SERVICE
I, _____________________________ (name), 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. I further certify that the service of this summons and a copy
of the complaint was made _________________________(date) by:
____ Electronically: Notice of Electronic Filing
____ Mail 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 Mail Service on an Insured Depository Institution: By sending the process by
certified mail addressed to the following officer 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)
Under penalty of perjury, I declare that the foregoing is true and correct.
____________________________________
____________________________________
Date
Signature
Print Name: _________________________________________
Business Address: ____________________________________
City: ______________________ State _________ Zip _______
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Parent category: Legal