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Affidavit Of Proof Of Service Form. This is a Oregon form and can be use in Lincoln Local County.
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Tags: Affidavit Of Proof Of Service, 4, Oregon Local County, Lincoln
FORM 4
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IN THE CIRCUIT COURT OF THE STATE OF OREGON
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FOR THE CO UNT Y OF LINCOLN
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In the Matter of the Marriage of
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,
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Petitioner,
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and
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,
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Res pon den t.
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STATE OF OREGON
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Coun ty of
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NO .
AFFIDAVIT OF PROOF
OF SERVICE
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I,
, swe ar/affirm und er oa th that:
(print name)
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I am a resident of the State of Oregon or of the state of service. I am a com petent person 18 years of age or
older. I am not an attorney fo r or a party to this c ase , or an office r, director or e m ployee of an y party to this cas e.
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On the
day of
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, 20
, I served the Sum m ons, Petition, Notice of
(month)
(year)
Continuance of Health Coverage, Certificate of Residency, Notice of Statutory Restraining Order Prevention Dissipation
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of Assets, and a copy of ORS 107.089
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respondent in ______________________________ County, State of _____________________.
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Yes
No in this case personally upon the above named
AFFIDAVIT OF PROOF OF SERVICE - Page 1 of 2
S.D.4(12/03)
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by delivering to th e re spondent a copy of those papers, e ach of which was certifie d to be a true copy of ea ch orig inal.
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Signature of Process Server
Address
Print or Type Name of Process Server
City
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Sta te
Zip
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Telephone or Contact Telephone Number(s)
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SUBSCR IBED AND SW ORN TO before me this
day of
(month)
, 20
, by
(year)
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(Print Nam e of Proces s Server)
NOTARY PUBLIC FOR OREGON / COURT CLERK
My C om m ission exp ires:
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Subm itted by:
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Print Name
Petitioner
Attorney for Petitioner
OSB No.
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Address or Contact Address
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City
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Telephone or Contact Telephone Number(s)
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Zip
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State
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AFFIDAVIT OF PROOF OF SERVICE - Page 2 of 2
S.D.4(12/03)
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