Circuit Court for City or County Name Street Address Apt # Case No. vs. Name Street Address Apt # ( City State Zip Code Area Code ) Telephone City State Zip Code ( Area Code ) Telephone Plaintiff Defendant AFFIDAVIT OF SERVICE (Certified Mail) (DOM REL 56) All Blanks Must Be Completed I certify that I served the following documents (Check all that apply): Writ of summons Date the summons for the Complaint/Petition/Motion listed below was issued Complaint/Petition/Motion: List name of complaint/petition/motion Domestic Case Information Report (DCIR Form) Financial Statement Show Cause Order and Petition: List type of petition Other: List all other documents served which were previously filed with this Court upon Name of person served on Date , , at Street Address City State Zip Code by certified mail, restricted delivery, return receipt requested. The original return receipt signed by Name of person served is attached and who is (1) a resident of the above-listed address: or (2) a person of suitable age and discretion in a relationship to the defendant of and that: (3) the above-listed address is the defendant's residence or usual place of abode. Also attached is a copy of any summons ("process") issued by the Court, the original of which I included in the certified mail service upon the person served. I certify that I am over eighteen (18) years of age and I am not the Plaintiff or the Defendant. I SOLEMNLY AFFIRM under penalties of perjury that the contents of the foregoing paper are true to the best of my knowledge, information, and belief. Date Name of person certifying service (signature) Name of person certifying service (printed or typed) Street Address of person certifying service City State Zip Code ( CC-DR 56 (Rev. 6/2010) Area Code ) Telephone Number of person certifying service American LegalNet, Inc. www.FormsWorkFlow.com