CV-506, 08/10 Affidavit of Mailing or Facsimile (Domestic Abuse/Harassment) 247813.12(2)(a), Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. STATE OF WISCONSIN, CIRCUIT COURT, COUNTY Publication Affidavit of Mailing or Facsimile Domestic Abuse Harassment Case No. Petitioner: Protected Person (If different than Petitioner) : - VS - Respondent: 1. The undersigned being first duly sworn, says that he/she placed a true copy of the following documents: Petition for Injunction Notice of Extension of Time for Hearing in an envelope postpaid for first-the envelope and the contents in the United States Mail in [City, State] , on [Date] . The envelope was addressed to: Name of Respondent Address of Respondent - OR - 2. The undersigned being first duly sworn, says that he/she sent a true copy of the following documents: Petition for Injunction Notice of Extension of Time for Hearing via facsimile to the respondent on [Date] . The facsimile was addressed to: Name of Respondent Facsimile Number of Respondent 3. I obtain this information. State of County of Subscribed and sworn to before me on Notary Public/Court Official Name Printed or Typed My commission/term expires: Signature Print or Type Name Address Address Date American LegalNet, Inc. www.FormsWorkFlow.com