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Affidavit Of Service (17AB) Form. This is a Oregon form and can be use in Circuit Court Statewide.
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Tags: Affidavit Of Service (17AB), Oregon Statewide, Circuit Court
IN THE CIRCUIT COURT OF THE STATE OF OREGON
FOR THE COUNTY OF_________________________
In the Matter of the Marriage of:
________________________________,
Petitioner,
and
________________________________,
Respondent.
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Case No. ______________________
AFFIDAVIT OF SERVICE
Personal Service (ORCP 7D(2)(a))
Substitute Service (ORCP 7D(2)(b))
Office Service (ORCP 7D(2)(c))
Service by Mail, Return Receipt Requested
(ORCP 7D(2)(d))
I,___________________________________________, declare I am a resident of the County
of_____________________, State of____________________. I am a competent person 18 years of age or
older and not a party to or attorney in this proceeding. I certify that the person, firm, or corporation served is the
identical one named in this action.
(Check one of the following):
1. Personal Service. On the _______day of
, 20____, at
a.m./p.m.,
I served a true copy of the original Petition for Annulment and Summons (with attached Notice of Statutory
Restraining Order Preventing Dissipation of Assets in Domestic Relations Actions, notices on mediation
and other information provided by the court clerk) by delivering them to Petitioner Respondent,
______________________________________(name) in person at the following address
___________________________within the County of _______________________, State of
2. Substitute Service. On the________day of________________, 20____,
at___________a.m./p.m., I served a true copy of the original Petition for Annulment and Summons (with
attached Notice of Statutory Restraining Order Preventing Dissipation of Assets in Domestic Relations
Actions, notices on mediation and other information provided by the court clerk) by delivering them
to_______________________(name), who is a person age 14 or older and a member of the household of the
party to be served, at the following address______________________________________within the County
of__________________, State of ________________. (Complete the section below only if the undersigned
performed the follow-up mailing required by ORCP 7D(2)(b). If a party or other person other than the
undersigned did the follow up mailing, s/he must use a separate Affidavit/Certificate of Mailing.)
On the__________day of__________________, 20______, I personally deposited a true copy of the
Petition and Summons with the United States Postal Service, via first class mail, in a sealed envelope, postage
prepaid, addressed to the party to be served: Petitioner Respondent ______________________________
(name), at the party’s home address listed above, together with a statement of the date, time and place that the
documents were hand-delivered to the party’s dwelling (residence).
AFFIDAVIT OF SERVICE - Page 1 of 2
Annul-17AB: AffServ17ABVer01.doc (3/08)
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3. Office Service. On the _________day of______________, 20____, at_____________
a.m./p.m., I served a true copy of the original Petition for Annulment and Summons (with attached Notice of
Statutory Restraining Order Preventing Dissipation of Assets in Domestic Relations Actions, notices on
mediation and other information provided by the court clerk) by delivering them, in person, to the office of the
party to be served, located at: _________________________________________(address), during normal
working hours for that office, where I left the documents with_____________________________ (name), who
is a person apparently in charge and who has a business duty to provide the documents to the party to be served.
(Complete the section below only if the undersigned performed the follow-up mailing required by ORCP
7D(2)(c). If a party or other person other than the undersigned did the follow up mailing, s/he must use a
separate Affidavit/Certificate of Mailing.)
On the ________day of______________________, 20_____, I personally deposited a true copy of
the Petition and Summons (with attached Notice of Statutory Restraining Order Preventing Dissipation of
Assets in Domestic Relations Actions, notices on mediation and other information provided by the court clerk)
with the United States Postal Service, via first class mail, in a sealed envelope, postage prepaid, addressed to the
party to be served: Petitioner Respondent ____________________________ (name), at the party’s:
home address located at: _______________________________________________(address), OR
business address, listed above, together with a statement of the date, time and place that the documents were
hand-delivered to the party’s office.
4. Service by Mail, Return Receipt Requested. On the_____ day of_______________, 20_____,
I personally deposited two true copies of the Petition for Annulment and Summons (with attached Notice of
Statutory Restraining Order Preventing Dissipation of Assets in Domestic Relations Actions, notices on
mediation and other information provided by the court clerk) with the United States Postal Service, one via first
class mail, and the other by certified or registered, return receipt requested, or by express mail, with postage on
both copies fully paid, addressed to the party to be served: Petitioner or Respondent
_________________ (name), at the party’s: home address located at: _______________________________
___________________________________________________________ (address). (NOTE: If mailed return
receipt requested, the return receipt should be attached to this Affidavit of Service.)
Certificate of Document Preparation. You are required to truthfully complete this certificate regarding the
document you are filing with the court. Check all boxes and complete all blanks that apply:
I selected this document for myself and I completed it without paid assistance.
I paid or will pay money to ____________________________ for assistance in preparing this form.
I hereby declare that the above statement is true to the best of my knowledge and belief, and that I
understand it is made for use as evidence in court and is subject to penalty for perjury.
Dated this _______ day of ______________________, 20 _____.
Signature of Server
Address or Contact Address
AFFIDAVIT OF SERVICE - Page 2 of 2
Annul-17AB: AffServ17ABVer01.doc (3/08)
Print Name
City, State, Zip
Telephone or Contact Telephone
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