AFFIDAVIT FOR SERVICE OF PROCESS ON THE SECRETARY OF THE COMMONWEALTH Commonwealth of Virginia VA. CODE §§ 8.01-301, -310, -329; 55-218.1; 57-51 Case No. ................................................................................ ................................................................................................................................................................................................................................. ..................................................................................................................... ..................................................................................................................... ..................................................................................................................... Circuit Court v. ..................................................................................................................... ..................................................................................................................... ..................................................................................................................... TO THE PERSON PREPARING THIS AFFIDAVIT: You must comply with the appropriate requirements listed on the back of this form. Attachments: [ ] Summons and Complaint [ ] Notice [ ] ......................................................................................................... I, the undersigned Affiant, state under oath that [ ] the above-named defendant [ ] .......................................................................................................................................................................... [ ] same as above [ ] ................................................................................................................................... whose last known address is 1. [ ] is a non-resident of the Commonwealth of Virginia or a foreign corporation and Virginia Code § 8.01-328.1(A) applies (see NON-RESIDENCE GROUNDS REQUIREMENT on page 2). 2. [ ] is a person whom the party seeking service, after exercising due diligence, has been unable to locate (see DUE DILIGENCE REQUIREMENT ON BACK) is the hearing date and time on the attached process or notice (if applicable). ................................................................. DATE ___________________________________________________________________________________________ [ ] PARTY [ ] PARTY'S ATTORNEY [ ] PARTY'S AGENT [ ] PARTY'S REGULAR AND BONA FIDE EMPLOYEE State of ........................................................ [ ] City [ ] County of ............................................................................................................................. ............................................................................................................................. PRINT NAME OF SIGNATORY Acknowledged, subscribed and sworn to before me this day by ................................................................. DATE ______________________________________________________________________ [ ] CLERK [ ] MAGISTRATE [ ] NOTARY PUBLIC Notary Registration No. ......................................... My commission expires: ................................ [ ] Verification by the clerk of court of the date of filing of the certificate of compliance is requested. A self-addressed stamped envelope was provided to the clerk at the time of filing this Affidavit. NOTICE TO THE RECIPIENT from the Office of the Secretary of the Commonwealth of Virginia: You are being served with this notice and attached pleadings under Section 8.01-329 of the Code of Virginia which designates the Secretary of the Commonwealth as statutory agent for Service of Process. The Secretary of the Commonwealth's ONLY responsibility is to mail, by certified mail, return receipt requested, the enclosed papers to you. If you have any questions concerning these documents, you may wish to seek advice from a lawyer. SERVICE OF PROCESS IS EFFECTIVE ON THE DATE WHEN SERVICE IS MADE ON THE SECRETARY OF THE COMMONWEALTH. CERTIFICATE OF COMPLIANCE I, the undersigned, Clerk in the Office of the Secretary of the Commonwealth, hereby certify the following: 1. On ................................................................................................... , legal service in the above-styled case was made upon the Secretary of the Commonwealth, as statutory agent for persons to be served in accordance with Section 8.01-329 of the Code of Virginia, as amended. 2. On ................................................................................................... , papers described in the Affidavit and a copy of this Affidavit were forwarded by certified mail, return receipt requested, to the party designated to be served with process in the Affidavit. _______________________________________________________________________ SERVICE OF PROCESS CLERK, DESIGNATED BY THE AUTHORITY OF THE SECRETARY OF THE COMMONWEALTH American LegalNet, Inc. www.FormsWorkFlow.com FORM CC-1418 (MASTER, PAGE ONE OF TWO) 07/13 NON-RESIDENCE GROUNDS REQUIREMENT: If box number 1 is checked, insert the appropriate subsection number: A court may exercise personal jurisdiction over a person, who acts directly or by an agent, as to a cause of action arising from the person's: 1. 2. 3. 4. Transacting any business in this Commonwealth; Contracting to supply services or things in this Commonwealth; Causing tortious injury by an act or omission in this Commonwealth; Causing tortious injury in this Commonwealth by an act or omission outside this Commonwealth if he regularly does or solicits business, or engages in any other persistent course of conduct, or derives substantial revenue from goods used or consumed or services rendered in this Commonwealth; Causing injury in this Commonwealth to any person by breach of warranty expressly or impliedly made in the sale of goods outside this Commonwealth when he might reasonably have expected such person to use, consume, or be affected by the goods in this Commonwealth, provided that he also regularly does or solicits business, or engages in any other persistent course of conduct, or derives substantial revenue from goods used or consumed or services rendered in this Commonwealth; Having an interest in, using, or possessing real property in this Commonwealth; Contracting to insure any person, property, or risk located within this C