AFFIDAVIT FOR SERVICE OF PROCESS ON THE SECRETARY OF THE COMMONWEALTH Commonwealth of Virginia Va. Code �� 8.01-301, -329; 55-218.1; 57-51 Case No. .............................................................................................. ......................................................................................................................................................................................... .............................................................................................................................. .............................................................................................................................. .............................................................................................................................. District Court v. .................................................................................................................................... .................................................................................................................................... .................................................................................................................................... TO THE PERSON PREPARING THIS AFFIDAVIT: You must comply with the appropriate requirements listed on the back of this form. Attachments: [ ] Warrant [ ] Motion for Judgment [ ] I, the undersigned Affiant, state under oath that: ............................................................................................................................................................... [ ] the above-named defendant [] .......................................................................................................................................................................................................... ............................................................................................................................................................................ whose last known address is: [ ] same as above [ ] ......................................................................................................................................................................................................................................................................................... 1. 2. [ ] is a non-resident of the Commonwealth of Virginia or a foreign corporation and Virginia Code � 8.01-328.1(A) ..................................... applies (see NON-RESIDENCE GROUNDS REQUIREMENT on reverse). [ ] is a person whom the party seeking service, after exercising due diligence, has been unable to locate (see DUE DILIGENCE REQUIREMENT on reverse) and that is the return date on the attached warrant, motion for judgment or notice (see TIMELY SERVICE REQUIREMENT on reverse). ....................................................................... DATE _____________________________________________________ [ ] PARTY [ ] PARTY'S ATTORNEY [ ] PARTY'S AGENT State of .............................................................................................................. Acknowledged, subscribed and sworn to before me this ....................................................................... NOTARY REGISTRATION NUMBER [ ] City [ ] County of .................................................................................................... ........................... ............................... day of .................................................................................... , 20 ___________________________________________________________________________ [ ] CLERK [ ] MAGISTRATE [ ] NOTARY PUBLIC (My commission expires ................................ ) [ ] Verification by the clerk of the court of the date of filing of the certificate of compliance requested. A self-addressed stamped envelope was provided to the clerk at the time of filing of this Affidavit. NOTICE TO THE RECIPIENT from the Office of the Executive Secretary of the Commonwealth of Virginia: You are being served with this notice and attached pleadings under Section 8.01-329 of the Code of Virginia which designates the Secretary of the Commonwealth as statutory agent for Service of Process. The Secretary of the Commonwealth's ONLY responsibility is to mail, by certified mail, return receipt requested, the enclosed papers to you. If you have any questions concerning these documents, you may wish to seek advice from a lawyer. SERVICE OF PROCESS IS EFFECTIVE ON THE DATE WHEN SERVICE IS MADE ON THE SECRETARY OF THE COMMONWEALTH. CERTIFICATE OF COMPLIANCE I, the undersigned, Clerk in the Office of the Secretary of the Commonwealth, hereby certify the following: 1. 2. On .............................................................................................................. , legal service in the above-styled case was made upon the Secretary of the Commonwealth, as statutory agent for persons to be served in accordance with Section 8.01-329 of the Code of Virginia, as amended. On .............................................................................................................. , papers described in the Affidavit and a copy of this Affidavit were forwarded by certified mail, return receipt requested, to the party designated to be served with process in the Affidavit. _______________________________________________________________________ SERVICE OF PROCESS CLERK, DESIGNATED BY THE AUTHORITY OF THE SECRETARY OF THE COMMONWEALTH FORM DC-410 FRONT 07/13 American LegalNet, Inc. www.FormsWorkFlow.com TIMELY SERVICE REQUIREMENT: Service of process in actions brought on a warrant or motion for judgment pursuant to Virginia Code � 16.179 or � 16.1-81 shall be void and of no effect when such service of process is received by the Secretary within ten days of any return day set by the warrant. In such cases, the Secretary shall return the process or notice, the copy of the affidavit, and the prescribed fee to the plaintiff or his agent. A copy of the notice of the rejection shall be sent to the clerk of the court in which the action was filed. NON-RESIDENCE GROUNDS REQUIREMENT: If box number 1 is checked, insert the appropriate subsection number: A court may exercise personal jurisdiction over a person, who acts directly or by an agent, as to a cause of action arising from the person's: 1. Transacting any business in this Commonwealth; 2. Contracting to supply services or th