Form Dr 56 – Fill Out and Use This PDF

Circuit Court for

Case No.

City or County

Name

Name

VS.

Street Address

Apt. #

PO Box

Street Address

Apt. #

PO Box

( )

( )

City

State Zip Code

Area

Telephone

City

State

Zip Code

Area

Telephone

Code

Code

Plaintiff

Defendant

AFFIDAVIT OF SERVICE

(Certified Mail)

(DOM REL 56)

I certify that I served the following documents (Check all that apply):

9Writ of Summons

9Complaint/Petition/Motion: _____________________________________________

(List name of complaint/petition/motion).

9Domestic Case Information Report (DCIR Form)

9Financial Statement

9Show Cause Order and Petition: __________________________________________

(List type of petition).

9Other: _____________________________________________________________

(List all other documents served).

which were previously filed with this Court upon

							Name of person served
on		,		, at
	Date				Street Address		City	State	Zip Code

by certified mail, restricted delivery, return receipt requested. The original return receipt signed

by		is attached. Also attached is a copy of any
	Name of person served

summons (‘process”) issued by the Court, the original of which I included in the certified mail

service upon the person served. I certify that I am over eighteen (18) years of age and I am not

the Plaintiff or the Defendant.

I SOLEMNLY AFFIRM under the penalties of perjury that the contents of the foregoing paper are true to the best of my knowledge, information, and belief.

Date		Name of person certifying service (signature)
		Name of person certifying service (printed or typed)
		Street Address		City	State	Zip Code
		of person certifying service
		(	)

Area Code Telephone Number of person certifying service

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DR 56 (Rev. 3/2006)