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SUPERIOR COURT OF THE DISTRICT OF COLUMBIAPlaintiff(s) vs. CIVIL DIVISION Defendant(s) j Civil Action No. ; 1 AFFIDAVIT OF SERVICE BY PROCESS SERVER I, , having been duly authorized to make service of the Summons, Complaint and Initial Order i\ n the above entitled case, hereby depose and say: That my age and date of birth are as follows: That my residential or business address is: That at o’clock am/pm on the day of ( ) I served the above named defendant(s) (personally) the Summons, Complaint and Initial Order at (defendant’s name) a copy of ( ) I served the above named defendant (s) (defendant’s name) by leaving a copy of the Summons, Complaint and Initial Order at his/her place of abode or business at with a person of approximately age, who stated that he/she resides therein with the defendant. years of If return receipt does not purport to be signed by the party named in th\ e Summons, then state specific facts from which the Courts can determine that the person\ who signed the receipt meets the appropriate qualifications for receipt of process as r\ equired by SCR. Civ. 4 (e) (2). SPECIFIC FACTS: Subscribed and sworn to before me this Signature day of 9 Deputy Clerk/Notary Public

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