For Clerk's Use Only Name of Person Filing: _______________________________________ Mailing Address: _______________________________________ City, State, and Zip Code: _______________________________________ Daytime / Evening Phone: _______________________________________ ATLAS Number (if applicable):_______________________________________ State Bar Number (if applicable):_____________________________________ Self (Without a Lawyer) OR Representing Plaintiff / Petitioner or Defendant / Respondent Attorney for SUPERIOR COURT OF ARIZONA MOHAVE COUNTY Case Number:________________________ (Name of Plaintiff / Petitioner) AFFIDAVIT OF SERVICE OF SUBPOENA (Name of Defendant / Respondent) I received the Subpoena addressed to ______________________________________________________ and dated at this time Name: Date: Place: Manner: ______________________________ on this date _______________________________ ______________________________ and I personally served it as follows: _________________________________________________________________________ _________________________________ Time: ________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ I declare under penalty of perjury that the foregoing is true and correct. Date: ___________________________________ Printed Name: Street Address: City, State, Zip: Phone: FEES MILEAGE OTHER TOTAL $_____________________ $_____________________ $_____________________ $_____________________ ______________________________________ Signature ______________________________________ ______________________________________ ______________________________________ ______________________________________ Revised: 5/31/2012 Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com