For Clerk’s Use Only Name of Person Filing: ______________________________________ Mailing Address: ______________________________________ City, State, and Zip Code: ______________________________________ Daytime Phone Number: ______________________________________ Evening Phone Number: ______________________________________ ATLAS Number (if applicable):______________________________________ State Bar Number (if applicable):____________________________________ Representing: Self Petitioner Respondent SUPERIOR COURT OF ARIZONA MOHAVE COUNTY Case Number: _______________________ (Name of Petitioner/Plaintiff) AFFIDAVIT OF SERVICE BY CERTIFIED MAIL AND (Name of Respondent/Defendant) 1. I am familiar with the facts stated in this Affidavit, and I make this Affidavit to show that I have served the court papers on the other party by certified mail, postage prepaid, return receipt requested, pursuant to Arizona rules of Civil Procedure, Rule 4.2(c). Person served (name of other party):__________________________________________________ Address where other party was served: ________________________________________________ Date of receipt by the other party:_____________________________________________________ Date of return of receipt to sender:____________________________________________________ 2. I know that the other party is located outside the State of Arizona. the following documents were sent to the other party by certified mail: (List all of the documents sent to the other party): _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ These court papers were received by the other party as shown by the receipt, a copy of which is attached to this Affidavit as required by Arizona Rules of civil Procedure, Rule 4.2(c). OATH OR AFFIRMATION State of Arizona Mohave County ) ) ss. I swear or affirm that the information on this document is true and correct under penalty of perjury. ___________________________________________________ Signature of Sender _____________________________ Date Sworn to or Affirmed before me this ______________ day of ______________________, 20_________ by _________________________________________ My Commission Expires: _______________________ 3/11/2010 ____________________________________ Deputy Clerk or Notary Public Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com