Free Sample Format (Affidavit of Service) - District of Columbia

UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLUMBIA

DO NOT WRITE ON SAMPLE FORM
PLAINTIFF(S) NAME(S)

vs.

CIVIL ACTION NO. (JUDGE'S INITIALS)

DEFENDANT(S) NAME(S) (et al. can be used on this form)

AFFIDAVIT OF SERVICE DO NOT WRITE ON SAMPLE FORM I, (name the person who actually mailed the summons/complaint), hereby declare that on the ________ day of ______________________, 20_____, I mailed a copy of the summons and complaint, certified mail return receipt requested, to (name of defendant). Attached hereto is the certified green card acknowledging service.

______________________________________________

STAPLE GREEN CARD HERE
Make sure it bears the original signature of the person who signed for the summons and complaint.

ORIGINAL SIGNATURE Typed or Written Name Street Address City, State & Zip Code Telephone Number