IN THE COUNTY COURT OF POLK COUNTY, FLORIDA CIVIL DIVISION CASE NO. _________________ Plaintiff, vs. Defendant. ______________________________/ AFFIDAVIT OF SERVICE BEFORE ME, the undersigned authority, personally appeared _______________, who, after being first duly sworn, deposes and says as follows: 1. That he is over the age of eighteen and is not a party to the litigation which is the subject matter of the above-styled cause of action. 2. That he received this process on the _____ day of ___________, 20____ and served same on the defendant on the _____ day of _________, 20___ at ________ .M. by serving a copy on _________________________________. 3. That he is disinterested in this process that he has served. __________________________________ _________________________ Title SWORN TO and subscribed before me this _____ day of ________, 20___. _______________________________________ NOTARY PUBLIC ____ Personall Known ____ Produced Identification Type of identification presented:_____________________ My Commission Expires: REV. 06/97 126.doc (06/97) 2000 © American LegalNet, Inc.