SC-5130V, 05/18 Affidavit of Mailing (Small Claims) 247247799.12 and 801.14, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional materials. Page 1 of 1 Enter the name of the county in which you are filing, or have already filed, this case. STATE OF WISCONSIN, CIRCUIT COURT, COUNTY Enter the name. Plaintiff(s): - vs - Defendant(s): Enter the name. Enter the case number. Affidavit of Mailing ( Small Claims ) Case No. After you have mailed the summons and complaint, or other document, you must complete the information to the right. U NDER OATH, I STATE: I placed in an envelope a copy of the following documents: Authenticated Copy of the Summons and Complaint Motion: Other: Enter the date [month, day, year] on which you placed the documents in a mailbox, and the name (s) and address (es) of the person to whom you mailed them. I mailed that envelope with proper postage affixed on [Date] to: Name Address Address City State Zip Name Address Address City State Zip STOP! Take this document to a Notary Public BEFORE you sign it. After you have been sworn by a Notary Public, sign and print your name and date the document in front of the Notary Public. Signature Print or Type Name Date Have the Notary Public sign, date, and seal the document. State of County of Subscribed and sworn to before me on Notary Public/Court Official Name Printed or Typed My commission/term expires: American LegalNet, Inc. www.FormsWorkFlow.com