Docketing Statement Template Page 8
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8CERTIFICATE OF SERVICE
I, _______________________________________ hereby certify that on
[appellant/petitioner or attorney therefor]
___________________________ I sent a copy of the foregoing Docketing Statement,
[date]
to:
_____________________________________, at ___________________________
[counsel for/or appellee/respondent]
___________________________________________________________________
________________________________________________, the last known address,
by way of United States mail or courier.
______________________________________
Signature
______________________________________
Dated signed
______________________________________________
______________________________________________
______________________________________________
______________________________________________
[Printed name and address of person completing service]
Page 8
D-2 Docketing Statement 11/01
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