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❑Municipal Court ❑County Court ODistrict Court <br />County, Colorado <br />Court Address: MONTRUSEU <br />CENTER <br />COUNTY JU Ti <br />WNTROSE �E <br />I go North Grand Avenue, Bin <br />Plaintiff (s) /Petitioner(s)�+oitfOge, CO 81401 <br />.a <br />V. <br />Defendant(s) /Respondent(s): c crl <br />A COURT USE ONLY <br />Attorney or Party Without Attorney Name and Address): <br />Case Number: t C, <br />Phone Number: E -mail: <br />FAX Number: Atty. Reg. #: <br />Division Courtroom <br />AFFIDAVIT & CERTIFICATE OF SERVICE <br />of <br />(address), state under oath or <br />certify that I am 18 years of age or older and am not a party to this action and that I served a copy of: <br />(name of document(s)), by personally <br />handing the papers to (state name of person) or by <br />(state other method of service) on (date), at (time), <br />at the following location <br />Signature of Process Server /Deputy <br />Name (Print or type) (If Deputy be sure to indicate) <br />• If you are not a Deputy, your signature must be witnessed by a Court Clerk or Notary Public. <br />Do not sign unless in their presence. <br />• After signing, give a copy of this Affidavit & Certificate of Service to the <br />Plaintiff(s) /Petitioner(s) and /or Defendant(s) /Respondent(s) and file the original with the <br />Court. <br />Subscribed and affirmed, or sworn to before me in the County of State of <br />, this day of 20 <br />My Commission Expires: <br />Notary Public /Clerk <br />JDF 409 R7/03 AFFIDAVIT & CERTIFICATE OF SERVICE <br />