SC-5120V, 05/18 Affidavit of Service of SC-500, Individual/Sole Proprietorship/Partnership Non-Eviction (Small Claims) 247247801.11 and 801.14, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional materials. Page 1 of 2 Enter the name of the county in which this case was filed. STATE OF WISCONSIN, CIRCUIT COURT, COUNTY Enter the name (s) as listed on the Summons and Complaint . Plaintiff(s): - vs - Defendant(s): Enter the name (s) as listed on the Summons and Complaint. Enter the case number. Complete one form for each defendant served. Each individual owner or partner must be served separately. Affidavit of Service of SC - 500 , Summons and Complaint Individual/ Sole Proprietorship/ Partnership N on - Eviction ( Small Claims ) Case No. For 1, check the box to ind icate the state where you live. Note: A party in this case cannot serve the summons and complaint on the defendant. UNDER OATH, I STATE: 1. I am an adult resident of the State of Wisconsin. Illinois. Iowa. Michigan. Minnesota . 2. I am not a plaintiff in this case. For 3, make sure that the served copy was signed at the time of service, and also included the time, date, place, manner of service, and upon whom service was made. 3. I served an authenticated copy of the Small Claims Summons and Complaint . At the time of service, I signed my name on the copy that was served ( for example, on the back or in any blank space) and indicated the time, date, place, manner of service, and upon whom service was made . For 4, check A or B or C. If 4A, fill in the address, date and time. 4. The manner of service was A. Individual: I gave a copy to the defendant personally at [Address] on [Date] at [Time] a.m. p.m. If 4B, fill in the name of the business, name of the person you served, the address, date, and time. B. Sole proprietor/partnership: I gave a copy to t he defendant who is the sole proprietor or a partner doing business under the name of by serving [Name] at [Address] on [Date] at [Time] a.m. p.m. I believe the person I served is the owner or a partner. If 4C, fill in the name, address, date, and time. If 4C, also explain what other efforts you made to find and serve the defendant personally before you left a copy with someone else. See Pre - Judgment: Basic Steps to Small Claims Service (SC - 6050V). C. Substituted service: I could not give a copy to the defendant, owner, or partner personally even after reasonable effort(s). I left a copy with a competent adult or a member of th e family at least 14 years of age currently the contents of the papers. I left a copy with [ N ame] at [ A ddress] on [ D ate] at [Time] a.m. p.m. Before leaving a copy, I made the following efforts to serve the defendant, owner, or partner personally: American LegalNet, Inc. www.FormsWorkFlow.com SC-5120V, 05/18 Affidavit of Service SC-500, Individual/Sole Proprietorship/Partnership Non-Eviction (Small Claims) 247247801.11 and 801.14, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 2 of 2 STOP! Take this document to a Notary Public BEFORE you sign it. After you, the server, 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 and date . 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