Proof of Service Form
Server's Name:
First Name
Last Name
Court documents were served to:
First Name
Last Name
Please select:
I gave court documents directly to the person named above.
I gave the documents to a person who lives at the same address as the party.
Date & Time of Service:
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Service address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please list all documents you served.
Fees charged for service ($):
Any other information about your service:
Signed place:
Signed date:
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Server's Signature
Submit
Should be Empty: