Legal Affirmation of Service

LEGAL AFFIRMATION OF SERVICE

This Legal Affirmation of Service is made and entered into by and between Client Name: and Service Provider Name: . The parties execute this Affirmation to document the facts and conclusions concerning the service of process described below.

RECITALS

WHEREAS, Client has requested that Service Provider effectuate service of certain court papers and related documents in the action captioned in Court: , Case Number: ;

WHEREAS, Service Provider represents that it is competent and authorized to perform process service in the relevant jurisdiction and that it will make a verifiable record of the means, date, time and circumstances of service; and

WHEREAS, the parties desire a written affirmation that the listed documents were attempted and/or completed in accordance with applicable rules and procedures.

NOW, THEREFORE

In consideration of the mutual covenants and agreements set forth below, the parties agree as follows:

1. DEFINITIONS

For purposes of this Affirmation, "Documents" means the papers identified in Section 2 below; "Service" means the delivery of Documents by one of the methods listed herein; "Affiant" means the individual who personally performed the Service and who makes the factual statements contained in this Affirmation.

2. AFFIRMATION OF SERVICE — FACTS

Description of Documents served (title and number of pages):

Person Served (if applicable): Relationship to Defendant/Plaintiff:

Location of Service (street address, city, state, ZIP):

Date of Service: Time of Service:

Method of Service (check all that apply):

Personal delivery to named individual Substituted service (left with competent adult) Certified mail/return receipt Electronic service (authorized)

Number of attempts prior to successful service:

Description of attempts or circumstances relevant to the service (include dates, times and responses observed):

3. AFFIANT REPRESENTATIONS AND CERTIFICATIONS

Affiant confirms and certifies that: (a) Affiant is at least eighteen (18) years of age; (b) Affiant is not a party to the matter described herein and has no interest adverse to the party served; (c) Affiant is competent to testify to the facts stated herein and made such observations personally; and (d) the statements set forth in this Affirmation are based upon Affiant's personal knowledge and, where stated to be based upon information and belief, are identified as such.

Jurisdiction under which the affirmation is made:

4. INDEMNIFICATION

Service Provider shall indemnify, defend and hold Client harmless from and against any claims, liabilities, losses, damages, costs or expenses (including reasonable attorney fees) arising out of Service Provider's material misstatement or omission in this Affirmation or Service Provider's gross negligence or intentional misconduct in carrying out the Service. This indemnity survives termination of this Affirmation.

5. FEES

Agreed fee for the service described in this Affirmation:

6. NOTICES

All notices required or permitted under this Affirmation shall be in writing and delivered to the addresses below by hand, certified mail, or overnight courier. Notices shall be effective upon receipt.

7. MISCELLANEOUS

Governing Law: This Affirmation shall be governed by and construed in accordance with the laws of the jurisdiction set forth in the Jurisdiction field above without regard to principles of conflicts of law.

Entire Agreement: This Affirmation constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous agreements, representations and understandings, whether oral or written.

Severability: If any provision of this Affirmation is held invalid or unenforceable, the remaining provisions shall remain in full force and effect and such invalid provision shall be replaced by a valid provision that most closely approximates the intent and economic effect of the invalid provision.

Amendment and Waiver: No amendment or waiver of any provision of this Affirmation shall be effective unless in writing and signed by both parties. No failure or delay by either party in exercising any right shall operate as a waiver of that right.

Counterparts: This Affirmation may be executed in counterparts, each of which shall be deemed an original, and all of which together shall constitute one instrument.

8. CERTIFICATION

I, the undersigned Affiant, declare under penalty of perjury under the laws of the jurisdiction identified above that the foregoing is true and correct to the best of my knowledge, information and belief.

Name of Affiant: Title/Capacity:

Contact telephone: Email:

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