This letter is intended to be used as an attachment to any type of correspondence.  It provides objective third party evidence useful in court to prove that an agent personally served (hand-delivered) a document to a specified individual on your behalf.  You will very commonly need this type of evidence when interfacing with the IRS, the state taxing authorities, or your employer, because they will frequently claim that they either never received the document or that they lost it, especially if some action or decision is expected that they don't want to deal with.

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PROOF OF PERSONAL SERVICE

Republic of _________________)

Subscribed and Affirmed            )

County of ___________________)

I, _________________________, the undersigned mailer/server, being of sound mind and under no duress, do hereby certify, attest and affirm that the following facts are true and correct, to wit:

1.              That, at the city of __________, County of __________________and the Republic of ___________________(statename), on the ____________________, 20__, that I, on behalf of _______________________a natural person, the undersigned personally delivered the following documents (listed below) inside the envelope to wit to the person identified below as recipient 

Item #	Document Description	Number of pages
1
2
3
4
5
6
7
8
9
10
11
12

Total of one (1) documents with combined total of thirty eight (20) pages.

2. That I am at least 18 years of age;

3.  That I am not related to _______________ by blood, marriage, adoption, or employment, but serve as a “disinterested third party” (herein “Server”); and further,

4.  That I am in no way connected to, or involved in or with, the person and/or matter at issue in this instant action.

I now affix my signature to these affirmations.

(Signature): _______________________________________________________, Recipient

(Signature): _______________________________________________________, Mailer/Server

(Printed name): ____________________________________________________