COURTS OF ARIZONA - NAME OF COURT Street Address Plaintiff: Date of Birth: -vsDefendant: City, Arizona Zip Code Court Case No.: Court No., NCIC: Court No., DPS: Phone Number CERTIFICATE OF SERVICE USE THIS FORM ONLY IF YOU ARE A PERSON AUTHORIZED UNDER A.R.C.P. 4 TO SERVE LEGAL PAPERS. The undersigned, being first duly qualified by law, swears or certifies that the following was served: [] Copy of the Petition and Order of Protection [] Copy of the Petition and Injunction Against Harassment [] Copy of the Petition and Injunction Against Workplace Harassment [] Notice of Hearing upon [ ] Plaintiff [ ] Defendant on (date) at (time) a.m. / p.m. at (address) , (year) Person Serving Process: [ ] Registered Process Server (MUST BE NOTARIZED) [ ] Peace Officer (NEED NOT BE NOTARIZED) Office or agency and identification number of Peace Officer: SUBSCRIBED AND SWORN to before me this date: Seal: Charges: Services $ Notary Public: My commission expires: Mileage $ Fees Paid $ Notary Fees $ TOTAL $ IN ACCORDANCE WITH A.R.S. 12-1809 AND 13-3602, THIS CERTIFICATE OF SERVICE MUST BE PROMPTLY FILED WITH THE CLERK OF THE ISSUING COURT NAMED ABOVE. Approved: July 2001 Certificate of Service: A.R.C.P., Rule 4; A.R.S. 12-1809(D)(K), 13-3602(D)(L) American LegalNet, Inc. www.USCourtForms.com