Pennsylvania Affidavit of Service

I, [Your Name], being duly sworn according to law, depose and state as follows:

Statement of Facts

1. I am over the age of eighteen (18) years and not a party to the action entitled [Case Name] pending in the [Court Name] of the Commonwealth of Pennsylvania.

2. On [Date of Service], at approximately [Time of Service], I served the following documents: [Type of Documents], pertaining to the aforementioned case.

3. The individual served was identified as [Recipient's Name], residing at [Recipient's Address], Pennsylvania.

4. The method of service utilized was [Specify Method of Service], in compliance with the Pennsylvania Rules of Civil Procedure.

5. I personally delivered the aforementioned documents to [Recipient's Name] at the stated address on the date and time mentioned above.

6. [Recipient's Name] acknowledged receipt of the documents by accepting them in my presence.

7. Attached hereto and marked as Exhibit A is a true and correct copy of the proof of service form completed and signed by me on the date of service.

Sworn Oath

I declare under penalty of perjury that the foregoing is true and correct to the best of my knowledge, information, and belief.

Signature

[Your Name]
Affiant

Subscribed and sworn to before me this [Day] day of [Month], [Year].

[Notary Public's Name]

Notary Public, State of Pennsylvania

My Commission Expires: [Expiry Date]

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