Divorce 7 – Proof of Service		
	Have the server complete this form after serving papers on your spouse 	
FL All Family 101: Proof of Personal Service	
Quick Instructions:	
	1.	Review the form. Write in the case number you got from the clerk when you filed your case.	
	2.	Have the server fill out details, date and sign the form. Be sure they complete sections 2, 3, and 4: 
•	Who was served (your spouse or someone who lives at your spouse’s home)
•	Date, time, and address of service
•	List all documents served	
	3.	Make 1 copy for yourself. 
(Take off this page first!)	
	4.	File the original with the court clerk. Stamp your copy with the date filed.	

Superior Court of Washington, County of Wahkiakum
In re the marriage of:
Petitioner (person who started this case):
Shane-Michael T. Renecker
And Respondent (other spouse):
Amielia Elizabeth Renecker	No.  
Proof of Personal Service 
(AFSR)	
Proof of Personal Service
Server declares:
1.	My name is: 	.  I am not a party to this case.  I am 18 or older.
2.	Personal Service
I served court documents for this case to (name of party): Amielia Elizabeth Renecker by (check one):
[  ]	giving the documents directly to him/her.
[  ]	giving the documents to (name): 	, 
a person of suitable age and discretion who lives at the same address as the party. 
3.	Date, time, and address of service
Date: 	 Time: 	 [  ] a.m.  [  ] p.m.
Address:
	
Number and street 	city	state	zip

4.	List all documents you served (check all that apply):

[X]	Petition for Divorce (Dissolution)	
[X]	Summons: Notice About a Marriage or Domestic Partnership	
[  ]	Other (Add names of any other documents served)
	
5.	Fees charged for service
[  ]	Does not apply.  
[  ]	Fees: $ _______ + Mileage $ _______ = Total: $________
6.	Other Information (if any): 	
	
I declare under penalty of perjury under the laws of the state of Washington that the statements on this form are true.
Signed at (city and state):  		Date: 	
			
Signature of server		Print or type name of server 

To the party having these documents served:
•	File the original Proof of Personal Service with the court clerk. 
•	If you served a Restraining Order signed by the court, you must also give a copy of this 
Proof of Personal Service and a Law Enforcement Information Sheet to law enforcement. 
•	If the documents were personally served outside of Washington state, you must fill out and file form FL All Family 102 (Declaration:  Personal Service Could Not be Made in Washington).
[  ]	To the Server:  check here if you personally served the documents outside Washington state.  Your signature must be notarized or sworn before a court clerk. 
(For personal service in Washington state, your signature does not need to be notarized or sworn before a court clerk.)
Signed and sworn to before me on (date):  	.
	
Signature of notary or court clerk
	
Print name of notary or court clerk
[  ]	I am a notary public in and for the state of: 	
My commission expires: 	
[  ]	I am a court clerk in a court of record in 
(county): 	
(Print seal above.)	(state):