Plaintiff vs. Defendant Person to be served (Name & Address): Superior Court of New Jersey Venue _____________________ Docket Number ______________ AFFIDAVIT OF SERVICE (For Use by Private Service) Attorney: Cost of Service pursuant to R. 4:4-3(c) $ Papers Served: Service Data: Served Successfully _____ Not Served Date: Time: ______________ Attempts: ___________ Delivered a copy to him / her personally Left a copy with a competent household member over 14 years of age residing therein (indicate name & relationship at right) Left a copy with a person authorized to accept service, e.g., managing agent, registered agent, etc. (Indicate name & official title at right) Name of Person Served and relationship / title: Description of Person Accepting Service: Sex: ____ Unserved: ) Defendant is unknown at the address furnished by the attorney ) All reasonable inquiries suggest defendant moved to an undetermined address ) No such street in municipality ) No response on: Date Time Date Time ( ) Other:____________________________ Comments or Remarks_______________________ Server Data: Subscribed and Sworn to me this ____ day of __________________ I, _____________________, was at the time of service a competent adult not having a direct interest in the litigation. I declare under penalty of perjury that the foregoing is true and correct. Signature of Process Server Date ( ( ( ( Age: ____ Height: Weight: ____ Skin Color: Hair Color: Notary Signature Name of Notary / commission expiration <Insert Private Server's name, address and telephone number.> Affidavit of Service (9/30/02) American LegalNet, Inc. www.FormsWorkflow.com page 1 of
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