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STATE OF SOUTH CAROLINA In the matter of Arbitration between

Claimant(s) vs.

Defendant(s)

) ) ) ) ) ) ) ) ) ) ) ) ) ) )

BEFORE THE ARBITRATION PANEL OF ____________________ COUNTY

Case number _______-CP-____-_______

AFFIDAVIT OF SERVICE (Claim Served Herewith)

The undersigned, __________________________, being duly sworn, states that he served the Summons for Arbitration and the Claim for Property Damage in this action on the Defendant(s), ____________________________________________________________, by delivering a copy (or copies) of the same to __________________________________, the Defendant(s) personally, or to __________________________________________ , the _____day of ________, ____, that affiant knows the person(s) so served to be the Defendant(s) or persons mentioned and described above, and that affiant is not a party to, nor interested in, the action.

Sworn to before me this ______ day of ________, ______.

Affiant

NOTARY PUBLIC FOR SOUTH CAROLINA My Commission expires:

SCCA/203(3/2005)