(Copy Receipt) (Clerks Date Stamp) SUPERIOR COURT OF WASHINGTON COUNTY OF SPOKANE In re the Petition for Change of Name of: CASE NO: ____________________________ _____________________________________ A Minor Child RETURN OF SERVICE OPTIONAL USE) (RTS) I DECLARE: 1. I am over the age of 18 years, and I am not a party to this action. 2. I served _________________________________ [Name] with the following documents: a copy of a petition in this action. notice of hearing. other: _____________________________________________________ 3. The date, time and place of service were (if by mail refer to Paragraph 4 below): Date: ________________ Time: ___________________/ Address: ____________________________________________________ RETURN OF SERVICE PETITION FOR CHANGE OF NAME PAGE 1 OF 2 (Rev: 10/2001) >>>> 2 4. Service was made pursuant to Civil Rule 4(d) by delivery to the person named in paragraph 2 above. Nam by delivery to ___________________________________ [Nam age and discretion residing at the respondents usual abode. by publication as provided in RCW 4.28.100. (A copy of the summons is attached.) (check only if there is a court order authorizing service by mail) by mailing two copies postage prepaid to the person named in the order entered by the court on __________________ [Date]. One copywas m ailed by ordinary first class mail, the other copy was sent by certified mail return receipt requested. (Attach return receipt below.) The copies were mailed on __________________________ [Date]. 5. Other: ________________________________________________________________________ I declare under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. Signed at____________________________, on_____________________________. [Place] [Date] ______________________________________ Signature _______________________________________ Print or Type Name Fees: Service _________________________ Mileage _________________________ Total _________________________ (Attach Return Receipt here, if service was by mail) RETURN OF SERVICE PETITION FOR CHANGE OF NAME PAGE 2 OF 2 (Rev: 10/2001)