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SUPERIOR COURT OF THE DISTRICT OF COLUMBIA CIVIL DIVISION, CIVIL ACTIONS BRANCH 500 Indiana Avenue, N.W., Room 5000 Washington, D.C. 20001 Telephone (202) 879-1133 Civil Action No. _____________ ________________________________ VS __________________________________ Plaintiff Defendant AFFIDAVIT OF SERVICE BY SPECIAL PROCESS SERVER I, ________________________________________, age 18 or older, residing or working at_________________________________________________, am not a party and have no interest in this case. On_____________________, 20_____, at___________ AM/PM. 1. I served a copy of the summons, complaint, initial order, and addendum if necessary, and any attachments as follows on defendant __________________________________. Personally at ____________________________________________________________. By leaving said copy with _________________________________________, a person of suitable age and discretion, who stated that he/she resides with the defendant at _________________________________________________________________. By leaving said copy with________________________________________________ at ______________________________________________________________________. He/She stated that they are authorized to accept service on behalf of the above defendant by statute or law and his/her official capacity is _________________________________. 2. Below, you must set forth specific facts from which the Court can determine that process was served as indicated above and in compliance with SCR CIV 4, including a physical description (approximate age, height, weight) of any person on whom service was made: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________ Special Process Server Subscribed and sworn to before me this _______ day of __________, 20 ____. _____________________________ Notary Public / Deputy Clerk _______________________ My Commission Expires NOTE: A separate Affidavit of Service is required for each named Defendant Form CV-3035/Jun 2011 American LegalNet, Inc. www.FormsWorkFlow.com