IN THE CIRCUIT COURT OF THE STATE OF OREGON COUNTY OF (See CIF) ) Petitioner (name of person to be protected) (date of birth) ) ) DECLARATION OF PROOF OF SERVICE ) (Elderly Persons and Persons With Disabilities by and through his/her Guardian Petitioner: ) Abuse Prevention Act) ) (name of Guardian Petitioner) v. (See CIF) ) ) Case No. ) ) Respondent (person to be restrained) (date of birth) ) ) I am a resident of the state of Oregon or of the state of service. I am a competent person 18 years of age or older. I am not an attorney for or a party to this case, or an officer, director, or employee of any party to this case. On the day of (month), 20 (year), I served the Restraining Order to Prevent Abuse of Elderly Person or Person with Disabilities; the Petition for Restraining Order to Prevent Abuse; Notice to Respondent/Request for Hearing; Notice to Elderly Person or Person with Disabilities/Objections Form/Request for Hearing; and other documents (list): in this case upon the above-named respondent elderly or disabled person in person (name): in County, State of , by delivering to the respondent or elderly or disabled person a copy of those papers, each of which was certified to be a true copy of the original. 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. Dated this day of , 2016. 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. Signature of Process Server Print Name Address City State Zip Telephone DECLARATION OF SERVICE EPPDAPA Obtain - Page 1 of 1 (EPPDAPA 8/2016) American LegalNet, Inc. www.FormsWorkFlow.com