IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE THIRD JUDICIAL DISTRICT
) ________________________________________, ) ) ) vs. ) ) ________________________________________, ) )
AFFIDAVIT OF SERVICE Case No. ______________________
I,___________________________________________, DO HEREBY CERTIFY THAT on the _______ day of _______________________, 20____, I served the within summons and/or petition(s) on the within named individual _________________________________ by delivering a copy
(Name of Person Served)
of said summons and/or petition to him/her personally and in person.
_________________________________ County of Service
_________________________________ Person Serving
SUBSCRIBED AND SWORN to before me on this _______ day of _______________________, 20___. NOTARY PUBLIC FOR OREGON/COURT ADMINISTRATOR
_________________________________________________ My Commission expires: ___________________________
AFFIDAVIT OF SERVICE - Page 1
FC (5/27/09)