STATE OF MAINE DISTRICT COURT Location Docket No. Plaintiff v. AFFIDAVIT AND REQUEST FOR SERVICE Small Claims - M.R.S.C.P. 4(b) Defendant I, , being duly sworn, depose and say: I am the plaintiff or representative of the plaintiff in this action. The plaintiff has not filed, and does not intend to file, three or more small claims actions in this State during this calendar month. Therefore, the plaintiff requests the clerk to arrange for service on the defendant or judgment debtor of the Statement of Claim Notice of Disclosure Hearing Date: Signature of Affiant Typed or printed name and address of affiant: Personally appeared the above-named oath that the foregoing statements are true. Date: and made Notary Public/Attorney/Clerk ****************************************************************************** AUTHORIZATION OF SERVICE BY SHERIFF I authorize the clerk to arrange for deputy service, and I understand I must pay the Sheriff's Department for the service. I do not authorize deputy service. If service cannot be made by mail, I request that the matter be dismissed without prejudice. I am willing to pay up to $ for deputy service. If service cannot be made for that amount or less, I request the Sheriff to return the Statement of Claim or Notice of Disclosure Hearing to the court unserved. I understand that I am responsible for the cost of a diligent search up to the above amount even if service is not made. If service cannot be made for the above amount or less, I request that the matter be dismissed without prejudice. Date: SC-006, Rev. 06/14 Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com Plaintiff