Proof of personal service

1234, Main Street
Boston, MA 02123

06 April, 2005

<Recipient Address Goes Here>



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>


Robert Anderson

encl: <List of enclosed items goes here>

Download notice that a default will be taken if an answer is not filed in Word Format

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