Legal Proof of Service Form

Legal Proof of Service Form
Use this form to record the details of a legal document service event, including the parties involved, what was served, how and when service was completed, and an attestation of accuracy.
Service Case Details
Case Number / Reference Number
Court or Matter Name
Jurisdiction / Venue
Document Title / Type Served
Serving Party and Recipient Information
Server full name
First NameMiddle NameLast Name
Server organization or company
Recipient full name
First NameMiddle NameLast Name
Recipient role or relationship to the case
Recipient mailing or service address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Recipient organization or company
Service Event Details
Method of Service
Other allowed method
Date of Service
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Time of Service
Hour Minutes
AM/PM Option
Service Location or Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Number of Service Attempts
Notes for Special Circumstances or Delivery Details
Proof, Declaration, and Signature
Server Signature
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Signed Date
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Witness Name
First NameMiddle NameLast Name
Should be Empty: