1020GEJ Approved February 26, 2018 / Revised May 1, 2019 Proof of Completed Service Page 1 of 5 Name Address City, State, Zip Phone Check your email. You will receive information and documents at this email address . Email In the [ ] District [ ] Justice Court of Utah Judicial District County Court Address Plaintiff/Petitioner v. Defendant/Respondent Proof of Completed Service ( U tah R ule of C ivil P rocedure 4 ) Case Number Judge Commissioner (domestic cases) 1. The following documents were served by the method described below (Choose all that apply.): [ ] Summons (File or attach copy.) [ ] Complaint or Petition [ ] Amended Complaint or Petition [ ] Notice of Divorce Education Requirements [ ] Notice of URCP 26.1 Disclosure and Discovery Requirements in Domestic Relations Actions [ ] Notice of URCP 26.3 Disclosure Requirements in Unlawful Detainer Actions [ ] Parenting Plan [ ] Other: (describe) American LegalNet, Inc. www.FormsWorkFlow.com 1020GEJ Approved February 26, 2018 / Revised May 1, 2019 Proof of Completed Service Page 2 of 5 Complete paragraph 2, or paragraphs 3 and 4. Service by Mail (Service by mail requires a signed receipt. Attach the receipt.) 2. [ ] I served the following person by sending a copy of the documents listed in Paragraph (1) by mail or commercial courier service to: Name of Addressee Address City, State, Zip I have attached a signed receipt proving delivery. It was signed by: [ ] the addressee personally. [ ] someone authorized by appointment or by law to receive service of process on behalf of the addressee. Service by Third Person 3. [ ] I am over the age of 18, and I am not a party or an attorney for a party to this action. I have not been convicted of a felony violation of a sex offense (Listed in Utah Code 77-41-102(16)). I am not a respondent in a protective order proceeding (Utah Code 78B-7-101 et seq.). 4. [ ] On (date), I went to (address), and I delivered the documents listed in paragraph 1 to (name), who is (Check one.): [ ] the named defendant/respondent. [ ] the named plaintiff/petitioner. [ ] a person of suitable age and discretion residing at that address, which is the residence. (Describe why the person livresidence and why they are of suitable age and discretion.) American LegalNet, Inc. www.FormsWorkFlow.com 1020GEJ Approved February 26, 2018 / Revised May 1, 2019 Proof of Completed Service Page 3 of 5 [ ] an agent authorized by appointment or by law to receive service of process on behalf of the named party. If serving a corporation, partnership, or an unincorporated association [ ] an officer, a managing agent, general agent. OR [ ] an agent authorized by appointment or by law to receive service of process and by also mailing a copy of the complaint and summons to the named party, if the agent is one authorized by statute to receive process and the statute so requires. If serving a city or town [ ] the city/town recorder. If serving a county [ ] the county clerk. If serving the state [ ] the attorney general, and to (name of any other person or agency required by statute to be served) at (address). If serving a department or agency of the state [ ] a member of governing board, executive employee or secretary. If the document was served in some other way [ ] Other (Describe how the document was served.) American LegalNet, Inc. www.FormsWorkFlow.com 1020GEJ Approved February 26, 2018 / Revised May 1, 2019 Proof of Completed Service Page 4 of 5 I decla re under criminal penalty under the law of Utah that everything stated in this document is true . Signed at (city, and state or country). Sign atu Date Printed Name American LegalNet, Inc. www.FormsWorkFlow.com 1020GEJ Approved February 26, 2018 / Revised May 1, 2019 Proof of Completed Service Page 5 of 5 Certificate of Service I certify that I filed with the court and am serving a copy of this Proof of Completed Service on the following people. Ser vice Method Service Address Service Date [ ] Mail [ ] Hand Delivery [ ] E - filed [ ] Email [ ] Left at business (With person in charge or in receptacle for deliveries.) [ ] Left at home (With person of suitable age and discretion residing ther e.) [ ] Mail [ ] Hand Delivery [ ] E - filed [ ] Email [ ] Left at business (With person in charge or in receptacle for deliveries.) [ ] Left at home (With person of suitable age and discretion residing there.) [ ] Mail [ ] Hand Delivery [ ] E - filed [ ] Email [ ] Left at business (With person in charge or in receptacle for deliveries.) [ ] Left at home (With person of suitable age and discretion residing there.) Sign atu Date Printed Name American LegalNet, Inc. www.FormsWorkFlow.com