SHERIFF'S OFFICE 50 NORTH DUKE STREET, P.O. BOX 83480, LANCASTER, PENNSYLVANIA, 17608-3480 - (717) 299-8200 SHERIFF SERVICE PROCESS RECEIPT, and AFFIDAVIT of RETURN PLEASE MAKE SURE FORM PRINTS LEGIBLY 1. PLAINTIFF/S/ 2. COURT DOCKET NUMBER 3. DEFENDANT/S/ 4. TYPE OF DOCUMENT TO BE SERVED SERVE AT 5. NAME OF INDIVIDUAL, COMPANY, CORPORATION, ETC., TO BE SERVED 6. ADDRESS (Street or RFD, Apartment No., City, Boro, Twp., State and ZIP Code) 7. INDICATE UNUSUAL SERVICE: DEPUTIZE OTHER Now, 20 , I SHERIFF OF LANCASTER COUNTY, PA., do hereby deputize the Sheriff of County to execute the writ and make return thereof according to law. This deputation being made at the request and risk of the plaintiff Sheriff of Lancaster County 8. SPECIAL INSTRUCTIONS OR OTHER INFORMATION THAT WILL ASSIST IN EXPEDITING SERVICE: NOTE ONLY APPLICABLE ON WRIT OF EXECUTION: N.B. WAIVER OF WATCHMAN - Any deputy sheriff levying upon or attaching any property under within writ may leave same without a watchman, in custody of whomever is found in posses sion, after notifying person of levy or attachment, without liability on the part of such deputy or the sheriff to any plaintiff herein for any loss, destruction or removal of any such property before sheriff's sale thereof. 9. SIGNATURE OF ATTORNEY Print Name OR OTHER ORIGINATOR 10. TELEPHONE NUMBER 11. DATE 12. SEND NOTICE OF SERVICE COPY TO NAME AND ADDRESS BELOW:(This area must be completed if notice is to be mailed) SPACE BELOW FOR USE OF SHERIFF ONLY DO NOT WRITE BELOW THIS LINE 13. I a cknowledge receipt NAME of authorized LCSO Deputy or Clerk of the writ Or complaint as indicated above 14. DATE RECEIVED 15. EXPIRATION/HEARING DATE 16. I Hereby CERTIFY and RETURN that I have personally served, have executed as shown in "Remarks", the writ or complaint described on the individual, company, corporation, etc., at the address shown above or on the individual, company, corporation, etc., at the address inserted below by handing a TRUE and ATTESTED COPY thereof . 17. I hereby certify and return a NOT FOUND because I am unable to locate the individual, company, corporation, ect., named above. 18.N ame and title of individua l Served (if not shown above) (Relationship to Defendant ) 19. No Servic See Remarks Below 20. Address of where served (Complete only if different than shown above)(Street or RFD, Apartment No., City, Boro,TWP, State and ZIP Code) 21. Date of Service 22. Time AM/PM E.S.T/E.D.S.T 23. Attempts Date Miles Dep. Int Date Miles Dep. Int Date Miles Dep. Int Date Miles Dep. Int Date Miles Dep. Int 24. Advance Costs 25. Service Costs 26. Notary Costs 27. Mileage/Postage/N.F. 28. Total Costs 29. COST DUE OR REFUND 30. Remarks S.T.A. 31. AFFIRMED and subscribed to before me this 34. day of 20 37. Prothonotary/Deputy/Notary Publlic MY COMMISSION EXPIRES SO ANSWER. 32. Signature of Dep Sheriff 33. Date 35. signature of Sheriff 36. Date , SHERIFF OF LANCASTER COUNTY PA Form revised 2/13/2013 American LegalNet, Inc. www.FormsWorkFlow.com