Bankruptcy Case No. Adversary Proceeding No. CERTIFICATE OF SERVICE I, , certify that I am, and at all times during the service of process was, not less than (name) 18 years of age and not a party to the matter concerning which service of process was made. I further certify that the service of this summons and a copy of the complaint was made by: (date) __ Mail service: Regular, first class United States mail, postage fully pre-paid, addressed to: __ Personal Service: By leaving the process with defendant or with an officer or agent of defendant at: __ Residence Service: By leaving the process with the following adult at: __ Certified Mail Service on an Insured Depository Institution: By sending the process by certified mail addressed to the following officer of the defendant at: __ Publication: The defendant was served as follows: [Describe briefly] __ State Law: The defendant was served pursuant to the laws of the State of , as follows: [Describe briefly] (name of state) Under penalty of perjury, I declare that the foregoing is true and corre ct. ___________________________________ __________________________________________ Date S ignature Print Name Jdkfljj _________________________________________________________________________ Business Address _________________________________________________________________________ City S tate Z ip [ver. 05/02]