Municipal Court County Court District Court _________________________________________ County, Colorado Court Address:

Plaintiff(s)/Petitioner(s): __________________________________
v.

Defendant(s)/Respondent(s): ______________________________ Attorney or Party Without Attorney (Name and Address): COURT USE ONLY Case Number:

Phone Number: FAX Number:

E-mail: Atty. Reg. #:

Division

Courtroom

AFFIDAVIT & CERTIFICATE OF SERVICE
I, , of (address), state under oath or certify that I am 18 years of age or older and am not a party to this action and that I served a copy of:

__________________________________________________________ (name of document(s)), by personally handing the papers to ___________________________________________ (state name of person) or by ______________________ (state other method of service) on _________________ (date), at _________ (time), at the following location ______________________________________________________________________.

___________________________________________ Signature of Process Server/Deputy

______________________________________ Name (Print or type) (If Deputy be sure to indicate)

If you are not a Deputy, your signature must be witnessed by a Court Clerk or Notary Public. Do not sign unless in their presence. After signing, give a copy of this Affidavit & Certificate of Service to the Plaintiff(s)/Petitioner(s) and/or Defendant(s)/Respondent(s) and file the original with the Court.

Subscribed and affirmed, or sworn to before me in the County of ______________________, State of ________________, this ___________ day of _______________, 20 _______.

My Commission Expires: ________________________

___________________________________ Notary Public/Clerk

JDF 409 R7/03

AFFIDAVIT & CERTIFICATE OF SERVICE