CIV-140 (6/01)(cs) AS 09.05.050 AFFIDAVIT OF PROOF OF SERVICE AT JAIL FACILITY IN THE DISTRICT/SUPERIOR COURT FOR THE STATE OF ALASKA AT ) ) ) Plaintiff, ) ) v. ) ) CASE NO. Defendant. ) ) AFFIDAVIT OF PROOF OF SERVICE AT JAIL FACILITY TO: Shift Supervisor at (Name of Jail or Correctional Facility)a. Serve the above-named defendant with the attached documents: Summons Complaint Subpoena Other Documents (List): b. Complete the "Affidavit of Proof of Service" below. c. Mail this completed form to: AFFIDAVIT OF PROOF OF SERVICE 1. I am the shift supervisor at , located at (Jail or Correctional Facility) , Alaska. (City) 2. On , 20 , I personally delivered the documents listed above to the above-named defendant . Signature of Shift Supervisor Print Name Subscribed and sworn to or affirmed before me at , Alaska, on , 20 . Notary Public in and for the State of Alaska My Commission Expires: American LegalNet, Inc. www.FormsWorkFlow.com