For Clerk's Use Only Name of Person Filing: ______________________________________ Mailing Address: ______________________________________ City, State, and Zip Code: ______________________________________ Daytime / Evening Phone: ______________________________________ ATLAS Number (if applicable):______________________________________ State Bar Number (if applicable):____________________________________ Self or Attorney for Representing: Petitioner Respondent (If Attorney, include State Bar Number) SUPERIOR COURT OF ARIZONA MOHAVE COUNTY _______________________________________ Name of Petitioner/Plaintiff _______________________________________ Name of Respondent/Defendant Case Number: ___________________________ AFFIDAVIT SUPPORTING SERVICE by CERTIFIED MAIL A.R.C.P. Rule 4.2(c), A.R.C.P. Rule 42 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) or Arizona Rules of Family Law Procedure, Rule 42. 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): ________________________________________________________________________________________ ________________________________________________________________________________________ OATH OR AFFIRMATION STATE OF ARIZONA County of Mohave ) ) ss. 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) or Arizona Rules of Family Law Procedure, Rule 42. _____________________________________________ Sender's Signature SWORN TO OR AFFIRMED before me this day of _____________________________ Date , 20 , by ___________________________________________ Printed Name of Person Who Signed My Commission Expires _____________________ ______________________________________ Notary Public / Deputy Clerk 10/18/2010 Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com