Full Name of Party Filing Document Mailing Address (Street or Post Office Box) City, State and Zip Code Telephone Email Address (If any) IN THE DISTRICT COURT FOR THE JUDICIAL DISTRICT FOR THE STATE OF IDAHO, IN AND FOR THE COUNTY OF Case No. AFFIDAVIT OF SERVICE , Respondent. State of Idaho, Department of Health and Welfare , Petitioner, vs. I certify: 1. I am a resident of County, State of , over the age of eighteen (18) years, and not a party to the above-entitled action. 2. On the day of , 20 I personally served copies of the , the above-named Father, on Mother, or Deputy Attorney General for the Department of Health and Welfare, in the County of , State of at (address) CERTIFICATION UNDER PENALTY OF PERJURY I certify under penalty of perjury pursuant to the law of the State of Idaho that the foregoing is true and correct. Date: AFFIDAVIT OF SERVICE GCS 2-4X 07/01/2016 PAGE 1 American LegalNet, Inc. www.FormsWorkFlow.com Typed/Printed Name Signature AFFIDAVIT OF SERVICE GCS 2-4X 07/01/2016 PAGE 1 American LegalNet, Inc. www.FormsWorkFlow.com