CERTIFICATE OF SERVICE

Caption Example

COMMONWEALTH OF KENTUCKY
[COUNTY] CIRCUIT COURT

[PLAINTIFF NAME],
Plaintiff,

v. Civil Action No. [CASE NUMBER]

[DEFENDANT NAME],
Defendant.

Certification Statement

Pursuant to Kentucky Rule of Civil Procedure 5, I certify that on [DATE OF SERVICE] the [TITLE OF DOCUMENT SERVED] was served on the following person(s):

• Recipient: [NAME]
• Capacity: [E.G., "Counsel for Defendant"]
• Service Address/Email: [CONTACT INFORMATION]
• Method(s):
• [ ] Electronic service through KCOJ eFiling system (registered user)
• [ ] Electronic mail (consent obtained)
• [ ] Hand delivery
• [ ] U.S. Mail, first-class postage prepaid
• [ ] Certified Mail / Courier
• Time of Service: [TIME]

[Repeat as needed for additional recipients.]

Additional Notes

• Mailing deposited at: [CITY, STATE].
• eFiling transaction ID: [ID].
• If serving a self-represented litigant or party exempt from eFiling, describe the authorized method: [DETAILS OR "N/A"].

Declaration

I certify under penalty of perjury that the foregoing is true and correct.

Date: [DATE]

[NAME OF SERVING ATTORNEY OR PARTY]
[KENTUCKY BAR NUMBER]
[FIRM NAME]
[ADDRESS]
[PHONE]
[EMAIL]
Attorney for [PARTY] / Pro Se [PARTY]

Practitioner Notes

• Verify compliance with CR 5.02 regarding proof of service requirements.
• Retain documentation for inclusion in appellate records under CR 76.12.
• Review local administrative orders for formatting or additional certificate language.