IN THE MATTER OF: o IN THE COURT OF COMMON PLEAS CHESTER COUNTY, PENNSYLVANIA o o ORPHANS COURT DIVISION o o AN ALLEGED INCAPACITATED PERSON o NO. AFFIDAVIT , (Petitioner or Attorney for Petitioner) hereby certifies that a copy of the Order Appointing a Guardian and the Notice of Right to Appeal and to Petition to Modify or Terminate the Guardianship has been served on (name of incapacitated person) , the Incapacitated Person on date by personal service at (place of service) by (person who served Notice) in the form attached hereto (attach copy of notice) which was read to the Incapacitated Per son, and a copy of same was served on (name of attorney) , Esquire, attorney for the Incapacitated Person, by (type of service) , on (date) . (Petitioner or Petitioners Attorney) (NOTARIZE IF SIGNED BY PETITIONER) American LegalNet, Inc. www.USCourtForms.com