AFFIDAVIT FOR APPOINTMENT AS A PRIVATE PROCESS SERVER CASE NO. ___________________________ Process Servers Information: Legal Name: ____________________________________________________________________ Current Address: ________________________________________________________________ Occupation and Employer: _________________________________________________________ Telephone Number: ______________________________________________________________ I, _____________________________________, being duly sworn under oath and penalty of perjury (Name of Process Server) do hereby state that I meet the following qualifications: (Indicate with initials each qualification that applies) ____ I am at least eighteen (18) years of age; ____ I am a citizen of the United States; ____ I have a high school diploma or equivalent; ____ I have not plead guilty or been convicted of a felony or a misdemeanor involving moral turpitude; ____ I am not a fugitive from justice or currently charged with a felony or misdemeanor involving moral turpitude; ____ I am not related to or employed by a party in the action; ____ I am of good moral character; and ____ I have not been disqualified by any Court to act as a process server within the preceding twelve (12) months. ___________________________________________ P rocess Servers Signature STATE OF MISSOURI ) COUNTY OF JACKSON ) SS. Subscribed and sworn to before me on _______________________________________________________ (Seal) ____________________________________________ Notary Public My Commission Expires:___________________________________________ Note: It is a Class A Misdemeanor to make a false affidavit for the purpose of misleading a public servant. Section 575.050 RSMo EXHIBIT A