IN THE COURT OF COMMON PLEAS OF CHESTER COUNTY, PENNSYLVANIA IN RE: , an incapacitated person Docket No. : 15 - AFFIDAVIT OF SERVICE OF CITATION WITH NOTICE & PETITION I, an adult, residing at hereby certifies that on , 20, at ( place ) I did give notice to ( alleged incapacitated person ) by personal service of the Citation with Notice and copy of the petition by reading the document/pleading to him/her and explaining the contents and terms of the petition to the maximum extent possible in language and terms he/she was most likely to understand. I also certify that notice of the petition and hearing was given to all persons who would be entitled to share in the estate of ( alleged incapacitated person ) if he/she died intestate and to the per son or institution providing residential service to ( alleged incapacitated person ) and other service providers by ( type of service ). Notice was given to: ( list persons/institutions to whom notice was given ). Verification I verify that the statements made in the foregoing AFFIDAVIT OF SERVICE OF CITATION WITH NOTICE & PETITION are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S. 2474904, relating to unsworn falsification to authorities. Dated: Signature: ** at least 10 days PRIOR to the hearing. ** American LegalNet, Inc. www.FormsWorkFlow.com