Fill and Sign the Dc Civil Form

___________________________ Hearing Date Superior Court of the District of Columbia CIVIL DIVISION SMALL CLAIMS AND CONCILIATION BRANCH AFFIDAVIT _______________________ Plaintiff VS. Case No. SC- ____________ _______________________ 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 is: ________________________________________ That my business address is: __________________________________________ That I am not a party to or otherwise interested in this suit.  A.M. T hat at ______ o’clock  P.M. on the _____ day of _______________, ______ I served the within named defendant(s) ________________________________________ by leaving a copy of the Statement of Claim and Notice at his/her usual place of abode or employment at: ____________________________________________________________________________Washington, D.C., with ____________________________________________, a person of suitable age and discretion, then residing therein, as directed by the Plaintiff, under Small Claims Rule 4. ____________________________________ Signature of Process Server Subscribed and sworn to before me this ______ day of _______________________________, ______. ____________________________________ Notary Public/Deputy Clerk