SUPERIOR COURT OF THE DISTRICT OF COLUMBIA CIVIL DIVISION, CIVIL ACTIONS BRANCH 500 Indiana Ave., N.W., Room 5000 Washington, D.C. 20001 Telephone (202) 879-1133 Case No. ___________________________________ Plaintiff ___________________________________ Address ___________________________________ vs. _____________________ ___________________________________ Defendant ___________________________________ Address ___________________________________ AFFIDAVIT OF SERVICE BY PRIVATE INDIVIDUAL ACTING AS SPECIAL PROCESS SERVER I, ___________________________________________, age 18 or older, residing or working at _______________ ____________________________________________________________________________________________ and not a party and without an interest in this case, state that on ___________________, 20__, at ______AM/PM: 1. I served a copy of the summons, complaint and initial order, if necessary, and any attachments as follows (check one of the following): On the Defendant____________________________ personally at ___________________________________ __________________________________________________________________________________________. By leaving said copy with ___________________________, a person of suitable age and discretion, who resides with Defendant at ____________________________________________________________________ ___________________________________________________________________________________________. (For a corporation, partnership, or association) I served ___________________________________, (check one of the following:) □ an officer □ a managing or general agent □ an agent authorized by appointment or law to receive service of process 2. You must set forth specific facts from which the Court can determine that process was served as indicated above and in compliance with SCR CIV 4, including a physical description (approximate age, height, weight) of any person on whom service was made: ____________________________________________________________________________________________ ____________________________________________________________________________________________ ___________________________________________________________________________________________ _____________________________________ Special Process Server Subscribed and sworn to before me this ______day of ____________, 20__. _____________________________________ Notary Public / Deputy Clerk ____________________________________ My commission expires □ New address for service NOTE: A separate Affidavit is required for service on each named Defendant American LegalNet, Inc. www.FormsWorkFlow.com