Fill and Sign the Proof of Personal Service Cowhatcomwaus Form

CR 4(g), RCW 4.28.080 Optional Form (07/201 9) FL All Family 101 Proof of Personal Service p. 1 of 3 Superior Court of Washington, County of In re: Petitioner/s (person/s who started this case) : And Respondent/s (other party/parties) : No. Proof of Personal Service (AFSR ) Proof of Personal Service Server declare s: 1. My name is: . I am not a party to this case . I am 18 or old er. 2. Personal Service I served court documents for this case to (name of party ): by (check one): [ ] giving the documents directly to him/her . [ ] giving the documents to (name) : , a person of suitable age a nd discretion who lives at the same address as the party. 3. Date, time, and address of service Date: Time: [ ] a.m. [ ] p.m. Address: Number and street city state zip 4. List all documents you served (check all that apply) : (The most commo n documents are listed below. Check only those documents that were served. Use the “Other” boxes to write in the title of each document you served that is not already listed.) CR 4(g), RCW 4.28.080 Optional Form (07/201 9) FL All Family 101 Proof of Personal Service p. 2 of 3 [ ] Petition to/for [ ] Summons (Attach a copy.) [ ] Notice of Hearing [ ] Order Setting Case Schedule [ ] Motion for Temporary Family Law Order [ ] and Restraining Order [ ] Notice Re Military Dependent [ ] Proposed Temporary Family Law Order [ ] Proposed Parenting Plan [ ] Motion for Immediate Restraining Orde r (Ex Parte) [ ] Proposed Child Support Order [ ] Immediate Restraining Order (Ex Parte) and Hearing Notice [ ] Proposed Child Support Worksheets [ ] Restraining Order [ ] Sealed Financial Documents [ ] Motion for Contempt Hearing [ ] Financial Declaration [ ] Order to Go to Court for Contempt Hearing [ ] Declaration of: [ ] Notice of Intent to Move with Children (Relocation) [ ] Declaration of: [ ] Objection about Moving with Children and Petition about Changing a Parenting/ Cust ody Order (Relocation) [ ] Other: [ ] Other: [ ] Other: [ ] Other: 5. Fees charged for service [ ] Does not apply . [ ] Fees: $ _______ + Mileage $ _______ = Total: $ ________ 6. Other Information (if any) : I declare under p enalty of perjury under the laws of the state of Washington that the statements on this form are true. Signed at (city and state): Date: Signature of server Print or type name of server To the party having these documents served :  File the origin al Proof of Personal Service with the court clerk.  If you served a Restraining Order signed by the court, you must also give a copy of this Proof of Personal Service and a Law Enforcement Information Sheet to law enforcement. CR 4(g), RCW 4.28.080 Optional Form (07/201 9) FL All Family 101 Proof of Personal Service p. 3 of 3 [ ] To the Server: check here i f you personally served the documents outside Washington state . Y our signature must be notarized or sworn before a court clerk. (For personal service in Washington state, your signature does not need to be notarized or sworn before a court clerk.) Signed and sworn to before me on (date): . Signature of notary or court clerk Print name of notary or court clerk [ ] I am a notary public in and for the state of : My commission expires: [ ] I am a court clerk in a court of record in (county ): (Print seal above.) (state):