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This is a District Of Columbia form that can be used for Small Claims and Conciliation Branch within Statewide, Superior Court.
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Hearing Date Superior Court of the District of Columbia CIVIL DIVISION SMALL CLAIMS AND CONCILIATION BRANCH AFFIDAVIT Plaintiff VS. Case No. SC- 1 Defendant I, having been duly authorized to make service of the Statement of Claim and Notice in the above entitled case, hereby deposes and says: That my age and date of birth are as follows: That my residential address i s : That my business address is: That I am not a party to or otherwise interested in this suit. I A*M* O defendant(s) 1 I served the within named That at o'clock, 0 P.M. on the day of Washington, D.C., by leaving a copy of the Statement of Claim and Notice at his/her usual place of abode or employment at: with therein, as directed by the Plaintiff, under Small Claims Rule 4. , a person of suitable age and discretion, then residing Signature of Process Server Subscribed and sworn to before me this ndw of Notary Public/Deputy Clerk 8.1051 ud268 2001 © American LegalNet, Inc.