IN THE COURT OF COMMON PLEAS PHILADELPHIA COUNTY
FIRST JUDICIAL DISTRICT OF PENNSYLVANIA
TRIAL DIVISION - CIVIL
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Plaintiff : TERM, 20
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v. : NO.
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Defendant :
RETURN OF SERVICE/AFFIDAVIT
I, _________________________________, hereby certify that I served a true and
correct copy of the Complaint / Notice of Appeal / Rule on _______________________,
1) By handing a copy to the Defendant / Appellee, __________________________,
on the ___ day of _______________, 20 , at ____________AM/PM, at
___________________________________________, Philadelphia, PA.
2) By handing a copy to __________________________________, an adult
member of the family/adult person in charge of Defendant’s / Appellee’s residence,
on the ___ day of _______________, 20 , at ____________AM/PM, at
__________________________________________, Philadelphia, PA.
I verify that the statements in this Return of Service are true and correct. I further verify
that I am an adult over the age of 18 and not related to any party in this action.
I understand that this unsworn document contains statements that are made subject to
the penalties of 18 P.C.S. §4904 relating to unsworn falsification to authorities.
Sworn to and Affirmed
This day 20
__________________ _____________________________ (Sign)
Notary Public
(SEAL) _____________________________ (Print Name)
Return of Service – rev. 4-27-15