GN-3120, 05/18 Affidavit of Service (Guardianship, Conservatorship, Protective Placement or Protective Services) 24724754.38, 54.76 and 55.09, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 1 of 1 STATE OF WISCONSIN, CIRCUIT COURT, COUNTY IN THE MATTER OF Name Date of Birth Amended Affidavit of Service (Guardianship, Conservatorship, Protective Placement or Protective Services) Case No. I, [Name] of [City] , State of , being sworn, state that on [Date] , I provided copies of the following documents : Documents provided: the original of which is on file a copy of which is attached to the following named persons at the address/facsimile number listed: See attached NAME ADDRESS TYPE OF SERVICE *** *** TYPE OF SERVICE : Refer to Wisconsin Statutes for proper manner of service. Type of Service : Personal S ervice Mail Certified mail return receipt requested FA X with transmittal receipt State of County of Subscribed and sworn to before me on Notary Public/Court Official Name Printed or Typed My commission/term expires: Signature Name Printed or Typed Address American LegalNet, Inc. www.FormsWorkFlow.com