REV 2/2019 JCB 1 DECLARATION OF PERSONAL SERVICE 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 (Name of person who completed service) Plaintiff / Petitioner, Defendant / Respondent. (Name of person served) (Street Address, City, State, and Zip Code of where served) Code: 1520 Name: Address: Telephone: Email: Self-Represented Litigant IN THE FAMILY DIVISION OF THE SECOND JUDICIAL DISTRICT COURT OF THE STATE OF NEVADA IN AND FOR THE COUNTY OF WASHOE , Case No. vs. Dept. No. , / DECLARATION OF PERSONAL SERVICE (To be filled out and signed by the person who served the Defendant or Respondent.) I, , declare: 1. I am not a party to this action and am over 18 years of age. 2. I am not a licensed process server; I am a natural person serving legal process without compensation, not more than three times per year, on behalf of a litigant who is a natural person, and therefore I am not required to be licensed pursuant to NRS 648.063(2). 3. I was able to complete service. 4. I personally delivered and left the document(s) with: The person to the case (Defendant / Respondent). I served the document(s) on the party at the location below. American LegalNet, Inc. www.FormsWorkFlow.com REV 2/2019 JCB 2 DECLARATION OF PERSONAL SERVICE 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 (Name of motion) (Street Address, City, State, and Zip Code of where served) (Name of person served) A person who lives with the person to the case. I served the document(s) on a person of suitable age and discretion who lives with the party at the location below. 5. I served the following document(s): (check all that apply) Summons; Complaint / Petition; Notice of Case Management Conference; Motion to ; Other: . 6. Service was completed on //, at the hour of A.M. 226OR226 P.M. This document does not contain the personal information of any person as defined by NRS 603A.040. I declare under penalty of perjury under the law of the State of Nevada that the foregoing is true and correct. * (The below information is of the person who completes service) Date: Signature: Printed Name: Address: Telephone Number: Email: * The penalty for willfully making a false statement under penalty of perjury is a minimum of 1 year, and a maximum of 4 years in prison, in addition to a fine of not more than $5,000.00. N.R.S. 247 199.145. American LegalNet, Inc. www.FormsWorkFlow.com