File Stamp AFFIDAVIT OF ATTEMPTED SERVICE UNSERVED DOCUMENTS Court Location: Case Name: Case No. I solemnly swear (or affirm) that the following facts are true to the best of my knowledge: I attempted to serve the following documents on the person named below: Documents: Person's Name: Company or other entity: Address: I was unable to serve the above documents because: Title: Fees authorized by Administrative Rule 11 and incurred by creditor: 1 Mileage Fee [Rule 11(a)(7)]: Fee for Excess Mileage [Rule 11(a)(7)]: (Total Miles Traveled to Attempt Service: TOTAL FEES (recoverable from debtor): ) $ $ $ Return Date Signature Print Name Subscribed and sworn to or affirmed before me at on . (SEAL) , Alaska Clerk of Court, Notary Public, or other person authorized to administer oaths. My commission expires 1 Fees may include local taxes but may not exceed the Rule 11 maximums. Civ. R. 79(f)(16) and Adm. R. 11. Adm. Rule 11 American LegalNet, Inc. www.FormsWorkFlow.com CIV-622 (8/10)(cs) AFFIDAVIT OF ATTEMPTED SERVICE UNSERVED DOCUMENTS