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Fill and Sign the I Am Familiar with the Facts Stated in This Affidavit and I Make This Affidavit to Show that I Have Served Copies Form

Fill and Sign the I Am Familiar with the Facts Stated in This Affidavit and I Make This Affidavit to Show that I Have Served Copies Form

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Person Filing: Address (if not protected): City, State, Zip Code: Telephone: Email Address: Lawyer’s Bar Number: Representing Self, without a Lawyer or Attorney for Petitioner OR Respondent SUPERIOR COURT OF ARIZONA IN ______________ COUNTY Case Number: Name of Applicant AFFIDAVIT OF SERVICE BY CERTIFIED MAIL 1. I am familiar with the facts stated in this Affidavit, and I make this Affidavit to show that I have s erved copies of the “Application for Change of Name” and the “Notice of Hearing Regarding Application for Change of Name” on the person named below by certified mail/restricted delivery, return receipt requested. Person served (name of other party): Address where other party was served: Date of receipt by the other party: 2. The Application and Notice listed above were received by the other party as shown by the receipt, the original of which is attached to this Affidavit on a separate piece of paper. UNDER OATH OR BY AFFIRMATION I swear or affirm under penalty of perjury that the contents o f this document are true and correct to the best of my knowledge and belief. Date Petitioner’s Signature STATE OF COUNTY OF Subscribed and sworn to or affirmed before me this: by (date) . (notary seal) Deputy Clerk or Notary Public For Clerk’s Use Only CVNC24f - 050115 Page 1 of 1 Use only most current version © S uperior Court of A rizona ALL RIGHTS RESERVED AFM

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