Free jc12a.p65 - Michigan

Approved, SCAO

JIS CODE: PSV

STATE OF MICHIGAN
JUDICIAL CIRCUIT - FAMILY DIVISION

PROOF OF SERVICE/NONSERVICE
USE NOTE: This form is not to be used for proof of service of a summons or for publication

CASE NO. PETITION NO.

COUNTY
Court address

Court telephone no.

1. In the matter of
(name[s], alias[es], DOB)

Date of hearing: as follows: I served the above papers, copies of which are either attached or were ordinary certified ADDRESS registered mail, addressed to

2. I served

(specify the titles of the papers served)

SERVICE BY MAIL

On

previously filed with the court, on the following person(s) by their last known address(es). NAME

I declare that this proof of service by mail has been examined by me and that its contents are true to the best of my information, knowledge, and belief.
Date Signature

PERSONAL SERVICE NAME

Copies of the above papers were served personally by me on the following person(s): PLACE OF SERVICE DATE AND TIME

I declare that this proof of personal service has been examined by me and that its contents are true to the best of my information, knowledge, and belief.
Date

Signature

NONSERVICE

After diligent inquiry, I have been unable to find and serve the following person(s): NAME REASON

I declare that this proof of nonservice has been examined by me and that its contents are true to the best of my information, knowledge, and belief.
Date JC 12a (9/06)

Signature

PROOF OF SERVICE/NONSERVICE

MCR 2.107(D), MCR 3.920(H)