Hearing Date Superior Court of the District of Columbia CIVIL DIVISION SMALL CLAIMS AND CONCILIATION BRANCH AFFIDAVIT Plaintiff VS. Case No. SC- 1 Defendant I, having been duly authorized to make service of the Statement of Claim and Notice in the above entitled case, hereby deposes and says: That my age and date of birth are as follows: I That my residential address i s : That my business address is: That I am not a party to or otherwise interested in this suit. A*M* O defendant(s) 1 I served the within named That at o’clock, 0 P.M. on the day of by leaving a copy of the Statement of Claim and Notice at his/her usual place of abode or employment at: Washington, with therein, as directed by the Plaintiff, under Small Claims Rule 4. D.C., , a person of suitable age and discretion, then residing Signature of Process Server Subscribed and sworn to before me this ndw of Notary Public/Deputy Clerk 8.1051 ud268 2001 © American LegalNet, Inc.