1 Code: 3860 2 Name: _______________________________ Address: _____________________________ ______________________________ Telephone Number: ____________________ Appearing in Proper Person 3 4 5 6 IN THE FAMILY DIVISION 7 OF THE SECOND JUDICIAL DISTRICT COURT OF THE STATE OF NEVADA 8 IN AND FOR THE COUNTY OF WASHOE 9 10 11 ______________________________________ Plaintiff/Petitioner, vs. Case No. ________________________ Dept. No. ________________________ 12 13 ______________________________________ Defendant/Respondent. __________________________________________/ 14 15 AFFIDAVIT OF PERSONAL SERVICE 16 STATE OF NEVADA 17 COUNTY OF WASHOE ) ) ) 18 19 _______________________________________________________ being first duly sworn, (Name of person who served the Order) 20 21 deposes and says under the penalties of perjury: 1. That I am a citizen of the United States, over 18 years of age, and am not a party to this 22 23 24 25 action. 2. That a copy of the EX-PARTE EMERGENCY MOTION and the ORDER were personally served upon ________________________________________________ on the _______ (Name of the person who was served) 26 27 day of _______________________, 20______, in the City of ______________________________, 28 by personally delivering a copy of such documents to the above-named person at the following Revised 2005 1 American LegalNet, Inc. www.USCourtForms.com 1 address: _________________________________________________________________________ 2 _______________________________________________________________________________. 3 4 DATED this _______ day of __________________________, 20______. 5 6 ____________________________________________ (Signature of person who served the Order) 7 8 9 10 SUBSCRIBED and SWORN to before me this _______day of _______________________, 20______. 11 12 _________________________________________ NOTARY PUBLIC 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 Revised 2005 2 American LegalNet, Inc. www.USCourtForms.com