IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR JACKSON COUNTY SMALL CLAIMS DEPARTMENT Plaintiff Case Number: vs. AFFIDAVIT OF MAILING FOLLOWING SUBSTITUTE SERVICE Defendant I, the undersigned, being first duly sworn on oath, depose and say: I, in the above entitled action; that on ,the Plaintiff the Claim and Notice of Claim was served on Date Served at and Party Served Address Served I did cause to be mailed a certified copy of the Claim and Notice of Claim in the United States mail at: , on Mailed from City, State Date Mailed postage prepaid thereon, in a sealed envelope, addressed to the last known address: Name: Address: City: State: OR __________________________________ Date Zip Code: _____________________________________________ Signature SUBSCRIBED AND SWORN TO BEFORE ME ON ____________________, in Jackson County, Oregon. Trial Court Administrator By: ___________________________________ Court Clerk/Notary Public My commission expires:___________________ SmClaims Affidavit of Mailing Following Substitute Service Page 1 of 1 12/15/09 American LegalNet, Inc. www.FormsWorkFlow.com