FORM DC-411 MASTER 07/18 SERVICE OTHER THAN BY VIRGINIA SHERIFF Case No. ................................................................................................. COMMONWEALTH OF VIRGINIA Va. Code 247247 8.01-296, 8.01-320, 8.01-325, 8.01-511 [ ] General District Court ......................................................................................................................................... [ ] Juvenile and Domestic Relations District Court ............................................................................................................... v./ In re: ................................................................................................................................... ........................................................................................................................................................................................................................................................................ is the name and address of the person upon whom service of the following is to be made. [ ] Warrant in Debt [ ] Summons for Unlawful Detainer [ ] Visitation [ ] Garnishment Summons [ ] Custody [ ] Support [ ] ............................................................................................................................................................................................................................................... I, the undersigned, swear/affirm that: 1.[ ] I am an official or an employee of an official who is authorized to serve process of type described in the attachedPROOF OF SERVICE and my title and bailiwick are: ..................................................................................................................................................................................................................................... OR [ ] I am a private process server: .......................................................................................................................................................................... NAME ..................................................................................................................................................................................................................................... ADDRESS AND TELEPHONE NUMBER OR [ ] I am an investigator employed by an attorney for the Commonwealth or the Indigent Defense Commission and have retired or resigned from my prior position as a law-enforcement officer in good standing. I affirm that the sheriff for the jurisdiction where process was served has agreed that such investigators may service process: ..................................................................................................................................................................................................................................... NAME AND TITLE ..................................................................................................................................................................................................................................... AGENCY 2.I am not a party to, or otherwise interested in, the subject matter in controversy in this case.3.I am 18 years of age or older.4.I served, as shown below, the above-named person upon whom service of process was to be made with copies describedabove.Date and time of service: .................................................................................................................................................................................. Place of service: ................................................................................................................................................................................................... STREET ADDRESS, CITY AND STATE Method of service: (If served outside of Virginia, use only personal service.) .................................................................................. DATE OF SIGNATURE SIGNATURE OF PERSON SERVING Name (print or type): ........................................................................................................................................................................................................................... [ ] Personal Service [ ] Other (allowed only in Virginia) [ ] Being unable to make personal service, a copy was delivered in the following manner: [ ] Delivered to family member (not temporary sojourner or guest) age 16 or older at usual place of abode of party named above after giving information of its purport. List name, age of recipient, and relation of recipient to party named above. List name, age of recipient, and relation of recipient to party: ......................................................................................................................................... [ ] Posted on front door or such other door as appears to be the main entrance of usual place of abode (other authorized recipient not found). [ ] (Garnishment Summons Only) Copy mailed to judgment debtor after serving the garnishee on date of service below unless a different date of mailing is shown. ........................................................................................................................................................... DATE OF MAILING [ ] Not Found American LegalNet, Inc. www.FormsWorkFlow.com FORM DC-411 MASTER 07/18 State of .................................................................... [ ] City [ ] County of ................................................................................................................................. Subscribed and sworn to/affirmed before me this day by .................................................................................... DATENOTARY PUBLIC (My Commission Expires ................................................... ) ....................................................................................... NOTARY REGISTRATION NUMBER American LegalNet, Inc. www.FormsWorkFlow.com