DISTRICT COURT OF WASHINGTON FOR KITSAP COUNTY 614 Division St. MS-25, Port Orchard, WA 98366 Phone: 360-337-7109 Fax: 360-337-4586 NO. Petitioner RETURN OF SERVICE HARASSMENT (RTS) vs. Respondent . I am a peace officer 18 years of age or older and 1. My name is not the petitioner. I was unable to make personal service on the respondent. I have notified the petitioner that 2. respondent was not served. Personal service was attempted on the following date(s): ________________________________ ________________________________________________________________________________ ________________________________________________________________________________ No service was attempted because _________________________________________________ ________________________________________________________________________________ 3. I served with the following documents: (name of person served) Temporary Order for Protection/Notice of Hearing Motion to Modify/Terminate Order for Protection Petition for an Order for Protection Other: Reissuance of Temporary Order for Protection and Notice of Hearing _________________________________ Order for Protection - Harassment 4. I served these documents on _______________________ at ____________________ at this address: (date) (time) ________________________________________________________________________________ 5. Other: ___________________________________________________________________________ I certify under penalty of perjury under the laws of the state of Washington that the foregoing is true and correct. DATED Fees: Service Mileage Total at , Washington. Signature of Server Law Enforcement Agency ** ALL HIGHLIGHTED BOXES/AREAS ON THIS FORM MUST BE CHECKED AND/OR COMPLETED OR IT WILL NOT BE ACCEPTED AS BEING PROPERLY SERVED RETURN OF SERVICE (HARASSMENT) (RTS) UH-04.0110 (6/2002) - RCW 10.14.011(4) Revised 05/15/06 American LegalNet, Inc. www.FormsWorkFlow.com