1234, Main Street
Boston, MA 02123
06 April, 2005
<Recipient Address Goes Here>
PROOF OF SERVICE BY MAIL
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 the date below, I served the foregoing document described as <title of document served> on the interested parties in this action by placing <a true copy/true copies> thereof enclosed in a sealed envelope, addressed as follows:
I caused such to be deposited in the United States Mail at <city, state where envelopes were mailed>. The <envelope/envelopes> <was/were> mailed with postage thereon fully prepaid.
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>