CERTIFICATE OF SERVICE

Caption Example

IN THE [CIRCUIT/CHANCERY] COURT FOR [COUNTY] COUNTY, TENNESSEE

[PLAINTIFF NAME],
Plaintiff,

v. Docket No. [CASE NUMBER]

[DEFENDANT NAME],
Defendant.

Service Statement

Pursuant to Tenn. R. Civ. P. 5, I certify that on [DATE OF SERVICE] the [TITLE OF DOCUMENT SERVED] was served upon the following person(s):

• Recipient: [NAME]
• Capacity: [E.G., "Attorney for Defendant"]
• Service Address/Email: [CONTACT INFORMATION]
• Method(s):
• [ ] Electronic service via [COURT E-FILING SYSTEM] (registered user)
• [ ] Electronic mail (written consent per Rule 5.02)
• [ ] Hand delivery / courier
• [ ] U.S. Mail, postage prepaid
• [ ] Certified Mail / Commercial carrier
• Time of Service: [TIME]

[Repeat bullet list for each additional recipient.]

Additional Notes

• Mailing deposited at: [CITY, STATE].
• E-filing transaction/reference number: [ID].
• If alternative service authorized by court order, describe: [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]
[TENNESSEE BPR NUMBER]
[FIRM NAME]
[ADDRESS]
[PHONE]
[EMAIL]
Attorney for [PARTY] / Pro Se [PARTY]

Practitioner Notes

• Retain proof of service for potential sanctions or appellate review.
• Confirm compliance with local rules (e.g., Davidson County Chancery Court) for any additional certification language.
• Redact sensitive information consistent with Tenn. Sup. Ct. R. 34 before serving documents.