Rule 17.200--Form 210: Affidavit of Service of Original Notice and Petition for Dissolution of Marriage Petitioner: Use this form only if someone other than Petitioner (you), or a person who is not a sheriff or a process server, delivered a copy of the Petition and Original Notice to Respondent (your spouse). · · The person, other than Petitioner, who gave the Petition and Original Notice to Respondent, fills in this form. Petitioner, or the person who gave the Petition and Original Notice to Respondent, must file this form with the clerk of court. 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 Petition is filed County Upon the Petition of Equity case no. Petitioner Full name: first, middle, last Affidavit of Service of Original Notice and Petition for Dissolution of Marriage and concerning Respondent Full name: first, middle, last 1. Affidavit I, , delivered a copy of the Original Notice and Name of person ­ Cannot be Petitioner, sheriff, or process server Check one a.m. Petition for Dissolution of Marriage for this case to: on Name of Respondent Month Day , 20 Year at Time p.m. by handing Respondent copies of the attached papers. 2. Oath and Signature To be completed by the person who gave the Petition and Original Notice to Respondent. I, Print your name , have read this Affidavit of Service, and I certify under penalty of perjury and pursuant to the laws of the State of Iowa that the information I have provided in this Affidavit of Service is true and correct. , 20 Signed on: Month Day Year Your signature* Mailing address City State ZIP code ( ) Email address Additional email address ­ if available Phone number * If you are filing electronically, scan the form after signing it and then file electronically. December 2013 Rule 17.200--Form 210 Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com