1234, Main Street
Boston, MA 02123
06 April, 2005
<Recipient Address Goes Here>
PROOF OF PERSONAL SERVICE
STATE OF <state>, COUNTY OF <county>
I am <employed in/a resident of> the County of <county>, State of <state> over the age of eighteen (18) years and not a party to the within action; my <business/home> address is <insert your business or home address>.
On <date service was effected>, the foregoing documents described as <title of document(s) served> <was/were> served on the interested parties herein in this action by placing <a true copy/true copies> thereof enclosed in an envelope addressed as follows:
I caused such envelope(s) to be delivered by hand to the offices of the addressee(s).
Executed on <date this form was signed>, at <City, State>.
I declare under penalty of perjury under the laws of the State of <state> that the above is true and correct.
<name of person effecting service>
encl: <List of enclosed items goes here>