EFTA00178532
| RETURN OF SERVICE¹ | |||
|---|---|---|---|
| RECEIVED BY SERVER | DATE | PLACE | |
| SERVED | DATE | PLACE | |
| SERVED ON (NAME) | |||
| SERVED BY | TITLE | ||
| STATEMENT OF SERVICE FEES | |||
| TRAVEL | SERVICES | TOTAL | |
| DECLARATION OF SERVICE² | |||
| I declare under penalty of perjury under the laws of the United States of America that the foregoing information contained in the Return of Service and Statement of Service Fees is true and correct. Executed on ___ Date ___ Signature of Server ___ Address of Server | |||
| ADDITIONAL INFORMATION | |||