Clear form
vs.
Plaintiff Defendant
Superior Court of New Jersey Venue Docket Number
Person to be served (Name & Address) :
AFFIDAVIT OF SERVICE
(For Use by Private Service)
Attorney:
Cost of Service pursuant to R. 4:4-3(c)
$
Papers Served: Service Data: Served Successfully ______________
_____
Not Served
Date:
Time: Attempts: ___________
Delivered a copy to him / her personally Left a copy with a competent household member over 14 years of age residing therein (indicate name & relationship at right) Left a copy with a person authorized to accept service, e.g., managing agent , registered agent, etc.
(Indicate name & official title at right)
Name of Person Served and relationship / title:
Description of Person Accepting Service: Sex: ____ Unserved: ( ( ( ( ) Defendant is unknown at the address furnished by the attorney ) All reasonable inquiries suggest defendant moved to an undetermined address ) No such street in municipality ) No response on: Date Time Date Time ( ) Other:____________________________ Comments or Remarks_______________________ Server Data: Subscribed and Sworn to me this ____ day of __________________ I,
Notary Signature
Name of Notary / commission expiration
Affidavit of Service (9/30/02)
Revised 9/30/2002, CN 10516-English
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