Fill and Sign the Proof of Service Request for Service District Form

CIV-562 (8/10) (cs) Civ. Rule 69(f)(3) and Admin. Rule 11 AFFIDAVIT – RETURN OF SERVICE FOR WRIT OF EXECUTION – SINGLE PERSON OR ENTITY AFFIDAVIT – RETURN OF SERVICE FOR WRIT OF EXECUTION – SINGLE PERSON OR ENTITY SERVED Partial Return Full Return of Service (Original writ must be attached.) File Stam p Court Location: Case No. Case Name: Debtor’s Name (list only one): I solemnly swear or affirm that the following facts are true to the best of my knowledge: I personally served the Wr it of Execution dated in the amount of $ by handing it to and leav ing a true and correct copy with the person named below: Person/Company/Other Entity: Alaska Permanent Fund Division at: Anchorage Fairbanks Juneau Other: Date of Service: Amount Received: Date Received: Check Date: Fees authorized by Administrative Rule 11 and incurred by creditor: 1 Service Fee [Rule 11(a)(1)(ii)]: $ Fee for Excess Hours [R ule 11(a)(1)(iii)]: $ (Total hours to obtain service: ) Mileage Fee [Rule 11(a)(7)] : $ Fee for Excess Mileage [Rule 11(a)(7)]: $ (Total miles traveled to obtain service: ) TOTAL FEES (recoverabl e from debtor): $ Return Date Signature Print Name Subscribed and sworn to or affirmed before me at , Alaska on . (SEAL) Clerk of Court, Notary Public, or other person authorized to administer oaths. My commission expires Process server notes: 1 Fees may include loca l taxes but may not exce ed the Rule 11 maximums. Civ. R. 79(f)(16) and Adm. R. 11.