Affidavit - Return Of Service For Writ Of Execution - Single Person Or Entity Served {CIV-562}

File Stamp AFFIDAVIT ­ RETURN OF SERVICE FOR WRIT OF EXECUTION ­ SINGLE PERSON OR ENTITY SERVED Partial Return Court Location: Case Name: Debtor's Name (list only one): I solemnly swear or affirm that the following facts are true to the best of my knowledge: I personally served the Writ of Execution dated in the amount of $ by handing it to and leaving a true and correct copy with the person named below: Person/Company/Other Entity: Alaska Permanent Fund Division at: Other: Date of Service: Date Received: Anchorage Fairbanks Juneau Full Return of Service (Original writ must be attached.) Case No. Amount Received: Check Date: Fees authorized by Administrative Rule 11 and incurred by creditor: 1 Service Fee [Rule 11(a)(1)(ii)]: Fee for Excess Hours [Rule 11(a)(1)(iii)]: (Total hours to obtain service: Mileage Fee [Rule 11(a)(7)]: Fee for Excess Mileage [Rule 11(a)(7)]: (Total miles traveled to obtain service: TOTAL FEES (recoverable from debtor): ) $ ) $ $ $ $ Return Date Signature Subscribed and sworn to or affirmed before me at on . (SEAL) Print Name , Alaska Clerk of Court, Notary Public, or other person authorized to administer oaths. My commission expires Process server notes: 1 Fees may include local taxes but may not exceed the Rule 11 maximums. Civ. R. 79(f)(16) and Adm. R. 11. CIV-562 (8/10) (cs) Civ. Rule 69(f)(3) and Admin. Rule 11 AFFIDAVIT ­ RETURN OF SERVICE FOR WRIT OF EXECUTION ­ SINGLE PERSON OR ENTITY American LegalNet, Inc. www.FormsWorkFlow.com