B250A - LF 7004 (12/09) UNITED STATES BANKRUPTCY COURT EASTERN DISTRICT OF WASHINGTON In re ) ) Debtor ) ) ) Plaintiff) ) ) Defendant) Bankruptcy Case No. Adversary Proceeding No. CERTIFICATE OF SERVICE I, _____________________________(name), certify that service of this summons and a copy of the complaint was made _______________________ (date), by: M ail service: Regular, first class United States mail, postage fully pre-paid, addressed to: Personal Service: By leaving the process with defendant or with an officer or agent of defendant at: Residence Service: By leaving the process with the following adult at: Certified M ail Service on an Insured Depository Institution: by sending the process by certified mail addressed to the following office of the defendant at: Publication: The defendant was served as follows: [Describe briefly] State Law: The defendant was served pursuant to the laws of the State of ___________________, as follows: [Describe briefly] If service was made by personal service, by residence service, or pursuant to state law, I further certify that I am, and at all times during the service of process was, not less than 18 years of age and not a party to the matter concerning which service of process was made. Under penalty of perjury, I declare that the foregoing is true and correct. ____________________________ DATE Print Name: Business Address: SIGNATURE ________________________________________ ________________________________________ ________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com
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