HOW TO VERIFY THE CONTENTS OF AN ENVELOPE
CERTIFICATE OF SERVICE
Republic of __________________)
Subscribed and Affirmed )
County of ______________________)
I, _________________________, the undersigned mailer/server, being of sound mind and under no duress, do hereby certify, attest and affirm that the following facts are true and correct, to wit:
1. That, on the _______________, 20___, that, on behalf of (name)_________________, a natural person, the undersigned personally deposited the following documents (listed below) inside the envelope, sealed them and transmitted them via the carrier indicated in item 2 below, to wit:
|Item |Document Description |Number |
|# | |of pages |
|1 | | |
|2 | | |
|3 | | |
|4 | | |
|5 | | |
|6 | | |
|7 | | |
|8 | | |
|9 | | |
|10 | | |
|11 | | |
|12 | | |
Total of ____ documents with combined total of __________ pages.
2. That I personally mailed said document(s) via (initial those which apply):
_______United States Postal Office, by regular mail, postage prepaid
_______United States Postal Office, by Certified Mail # ____ ____ ____ ____ ____,
Return Receipt Requested
_______United Parcel Service (UPS), tracking number # _____________________
_______Federal Express, tracking number # ____________________
_______Other (specify): ___________________________________________________________________
at said City and State, one (1) complete set of ORIGINAL/COPIED (circle one) documents, as described in item 1 above, properly enveloped and addressed to (addressee and address):
3. That I am at least 18 years of age;
4. That I am not related to _______________ by blood, marriage, adoption, or employment, but serve as a “disinterested third party” (herein “Server”); and further,
5. That I am in no way connected to, or involved in or with, the person and/or matter at issue in this instant action.
I now affix my signature to these affirmations.
(Signature): _______________________________________________________, Mailer/Server
(Printed name): ____________________________________________________
NOTARY PUBLIC’S JURAT
BEFORE ME, the undersigned authority, a Notary Public, of the County of
_________, Republic of __________(statename), this _______ day of ________________________, 20___,
___________________________________mailer/server did appear and was identified by
driver’s license and who, upon first being duly sworn and/or affirmed, deposes and says that
the aforegoing asseveration is true to the best of his/her knowledge and belief.
WITNESS my hand and official seal.
/s/_______________________________________________________SEAL
Notary Public
My Commission Expires On:
................
................
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