Person Filing: Address (if not protected): City, State, Zip Code: Telephone: Email Address: Lawyer's Bar Number: Representing Self, without a Lawyer or Attorney for Petitioner OR Respondent For Clerk's Use Only SUPERIOR COURT OF ARIZONA IN MARICOPA COUNTY In the matter of: Case Number: CV AFFIDAVIT OF SERVICE BY CERTIFIED MAIL Name of Minor whose birth certificate needs correction 1. I am familiar with the facts stated in this Affidavit, and I make this Affidavit to show that I have served copies of the "Petition to Amend Birth Certificate for a Minor" and the "Notice of Hearing Regarding Petition to Amend Birth Certificate for a Minor" on the person named below by certified mail/restricted delivery, return receipt requested. Person served (name of other party): Address where other party was served: Date of receipt by the other party: 2. The Application and Notice listed above were received by the other party as shown by the receipt, the original of which is attached to this Affidavit on a separate piece of paper. UNDER PENALTY OF PERJURY The contents of this document are true and correct to the best of my knowledge and belief. Date Signature of Sender Printed Name of Sender STATE OF COUNTY OF Subscribed and sworn to or affirmed before me this: (date) . by (notary seal) © Superior Court of Arizona in Maricopa County ALL RIGHTS RESERVED AFM Page 1 of 1 Deputy Clerk or Notary Public CVABM24f - 050115 American LegalNet, Inc. www.FormsWorkFlow.com