Bottom
:
:
:
:
:
:
:
:
:
:
:
 
No.  

AFFIDAVIT OF SERVICE


 , the undersigned, hereby state that
  (name of person who served the papers)  
 
 a copy of the
  (served/attempted to serve)  
 
  Notice of Hearing and Order, Petition and Temporary Order
 
  (description of documents served)
 
 
in the above-captioned action.


Service was made upon Defendant by handing the papers to:
    (name of individual to whom papers were given)
    at the following address: on this date:
   
   
      at approximately:     
      (approximate time of day)     

Service was not made upon Defendant but was attempted by:
 

Service by regular and certified mail was   ,
    (made/attempted)
                       pursuant to the Order of Court dated 
                       upon Defendant at the following address 
     
                      Proof of   has been filed with the Prothonotary.
                                      (service/no service)  

  Additional Notes:  
   


I verify that the statements made in this Affidavit are true and correct to the best of my knowledge and belief. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S. 4904, relating to unsworn falsification to authorities.
   


(Title of person who served the papers)
 


(Address of person who served the papers)
 
M D YYYY
(Date of this Affidavit)
THIS FORM MUST BE COMPLETED AND SIGNED BY THE PERSON WHO SERVES THE DEFENDANT WITH THE NOTICE OF HEARING AND ORDER, PETITION AND TEMPORARY ORDER. IT MUST BE FILED WITH THE PROTHONOTARY OR BROUGHT TO THE COURT ON THE HEARING DATE.



Top