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):____________________________________ Self Representing: Petitioner Respondent SUPERIOR COURT OF ARIZONA MOHAVE COUNTY Case Number: _______________________ (Name of Petitioner/Plaintiff) AND AFFIDAVIT SUPPORTING OUT-OF-STATE SERVICE (Name of Respondent/Defendant) A.R.C.P. 4.2(b)); A.R.F.L.P. 42(B) (Required to be filed prior to any default) As required by Arizona rules of civil Procedure, Rule 4.2(b), or Arizona Rules of Family Law Procedures, Rule 4.2(B), I am filing this Affidavit to inform the court why service was made by a person authorized to serve process under the law of the state where such service was made. 1. Reason for service by process outside the State of Arizona: x The other party resides or works outside the State of Arizona. x Other Reason: ____________________________________________________________________ 2. I have attached the Affidavit of the person who served the papers upon the other party, including a statement of the date, time, and circumstances of delivery. 3. The Affidavit indicates the person who served the papers is: x A licensed or registered process server in the state where the papers were served. x Sheriff, Deputy Sheriff, or other law enforcement x Other person authorized to serve process under the laws of the state where service is made, namely: ____________________________________________________________ OATH OR AFFIRMATION State of Arizona Mohave County ) ) ss. By signing this document, I state to the court under penalty of perjury that its contents are true and correct to the best of my knowledge and belief. ___________________________________________________ _____________________________ Signature Date Sworn to or Affirmed before me this ______________ day of ______________________, 20_________ by _________________________________________ My Commission Expires: _______________________ 10/12/2010 ____________________________________ Deputy Clerk or Notary Public Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com