SC-5110V, 05/18 Affidavit of Service of SC-500, Summons and Complaint Corporation or LLC Non-Eviction (Small Claims) 247799.12, 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 as it is listed on the Summons and Complaint . Plaintiff(s): - vs - Defendant(s): Enter the name as it is listed on the Summons and Complaint. Enter the case number. Amended Affidavit of Service of SC - 500 , Summons and Complaint Corporation or Limited Liability Company (LLC) Non - E viction (Small Claims) Case No. Note : A party in this case c annot serve the summons and complaint on the defendant . U NDER OATH, I STATE : For 1, check the box to ind icate the state where you live. 1. I am an adult resident of the State of Wisconsin. Illinois. Iowa. Michigan. Minnesota . 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. 2. I am not a plaintiff in this case. 3. I served an authenticated copy of the Small Claims Summ ons 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 4A, or 4B, or 4C. If 4A, fill in the address, date and time. 4. The manner of service was A. I gave a copy to the person who I knew to be an officer, director or managing agent of the corporation/LLC with [Name] at [Address] on [Date] at [Time] a.m. p.m. If 4B, fill in the name, address, date, and time. If 4B, also explain what other efforts you made to find and serve the officer personally before you left a copy with someone else . B. I could not give a copy to an officer, director or managing agent of the corporation/LLC personally even after reasonable effort(s). I left a copy with the person who is apparently in charge o f the office . I informed that person of the contents of the papers. I left a copy with [Name] at [Address] on [Date] at [Time] a.m. p.m. Before leaving a copy, I made the following efforts to serve the defendant personally: See Pre - Judgment: Basic S teps to Small Claims Service (SC - 6050V). C. I gave a copy to an agent authorized by appointment or by law to accept service of the summons for the defendant. American LegalNet, Inc. www.FormsWorkFlow.com SC-5110V, 05/18 Affidavit of Service of SC-500, Summons and Complaint Corporation or LLC Non-Eviction (Small Claims) 247799.12, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional materials. 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, 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