Free Local Form LF7004 - CERTIFICATE OF MAILING SUMMONS - Washington

LF 7004.CT1 (5/96)

UNITED STATES BANKRUPTCY COURT EASTERN DISTRICT OF WASHINGTON
In re ) Bankruptcy Case No. ) Debtor ) ) ) Adversary Proceeding No. Plaintiff) ) CERTIFICATE OF MAILING ) SUMMONS ) Defendant)

I, , certify that I am, and at all times du ring the service of proce ss wa s, not less than 18 ye ars of a ge an d not a party to the matter co ncern ing w hich serv ice of pro cess w as made. I further certify that the service of the summons (attached) and a copy of the complaint was made , by: (DATE ) M ail service: Regular, first class United States mail, postage fully pre-paid, addressed to:

Persona l Service: By leaving the p rocess with defend ant or w ith an officer or agent of defen dant at:

Residence Serv ice: By leaving the pro cess with the following a dult at:

Publication: The defendant was served as follows: [Describe briefly]

State Law : The defenda nt wa s served pursuan t to the laws of the State o f

, as follow s:

UNDER PENA LTY OF PERJUR Y, I DECLARE TH AT THE FOR EGOING IS TRUE AND CO RRECT:

DATE

SIGNATURE

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