Rule 17.100--Form 125: Affidavit of Mailing Notice If you do not understand how to use this form, or if you should use this form, talk to an attorney. In the Iowa District Court for County where your case is filed County Upon the Petition of Equity case no. Affidavit of Mailing Notice Petitioner Full name: first, middle, last and concerning Respondent Full name: first, middle, last 1. Attorney Help Check one A. B. An attorney did not help me prepare or fill in this paper. An attorney helped me prepare or fill in this paper. If you check B, you must fill in the following information: Name of attorney or organization, if any Attorney's P.I.N. # ­ Ask the attorney Business address of attorney or organization City State ZIP code ( ) ( ) Attorney's email address ­ optional Attorney's phone number Attorney's fax number ­ optional Important Notice to Petitioner Petitioner must file this if he or she served Notice by Publication in a newspaper and asks the court for a divorce Decree by default. Petitioner must also complete the oath and signature section on the next page. Petitioner's Oath and Signature on next page November 2013 Rule 17.100--Form 125 Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com Rule 17.100--Form 125: Affidavit of Mailing Notice, continued 2. Petitioner's Oath and Signature I, Print your name , certify under penalty of perjury and pursuant to the day of Day Month laws of the State of Iowa that on the , 20 Year , I sent by ordinary mail with proper postage, the following paper or papers: Check one Original Notice and Petition for Dissolution of Marriage, or Notice of Intent to File a Written Application for Default Decree to Respondent's last-known address as follows: . Respondent's street address City State ZIP code , 20 Signed on: Month Day Year Petitioner's signature* Mailing address City State ZIP code ( ) Email address Additional email address ­ if available Phone number * Whether filing electronically or in paper, you must handwrite your signature on this form. If you are filing electronically, scan the form after signing it and then file electronically. November 2013 Rule 17.100--Form 125 Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com