Circuit Court for Name Street Address Case No. City or County Name Apt. # VS. Street Address Apt. # ( City State Zip Code ) Area Telephone Code City State Zip Code ( Defendant ) Area Code Telephone Plaintiff CERTIFICATE OF SERVICE (DOM REL 58) I HEREBY CERTIFY that on this of the document(s) entitled was/were mailed, postage prepaid to: Opposing Party or His/Her Attorney day of Title of Document(s) , , a copy Address City State Zip Date Signature Page 1 of 1 DR 58 - Revised 13 February 2001 American LegalNet, Inc. www.FormsWorkflow.com