Kentucky Service Affidavit (Return of Service)

AFFIDAVIT OF SERVICE

Commonwealth of Kentucky

IN THE [________________________________] COURT

[________________________________] COUNTY, KENTUCKY

Civil Action No.: [________________________________]
Division: [________________________________]

[________________________________],
Plaintiff(s),

v.

[________________________________],
Defendant(s).

AFFIDAVIT OF SERVICE

(Pursuant to Kentucky Rules of Civil Procedure CR 4.01–4.06)

I. AFFIANT IDENTIFICATION

I, [________________________________], being first duly sworn, state under oath as follows:

1. Full Legal Name: [________________________________]

2. Business Address: [________________________________]

3. City, State, ZIP: [________________________________]

4. Telephone: [________________________________]

5. Email (optional): [________________________________]

6. Capacity (check one):

☐ Sheriff of [________________________________] County, Kentucky

☐ Deputy Sheriff of [________________________________] County, Kentucky

☐ Constable of [________________________________] County, Kentucky

☐ Court-Appointed Special Bailiff / Private Process Server (Order dated [__/__/____] attached as Exhibit A)

☐ Other person authorized by the Court (describe): [________________________________]

7. I am at least 18 years of age, competent to testify, and not a party to the above-captioned action.

8. I have personal knowledge of the facts stated herein.

II. DOCUMENTS SERVED

The following documents (collectively, the "Documents") were served:

☐ Summons

☐ Complaint / Verified Complaint

☐ Amended Complaint

☐ Counterclaim / Cross-Claim / Third-Party Complaint

☐ Subpoena

☐ Motion for [________________________________]

☐ Order of Court dated [__/__/____]

☐ Notice of [________________________________]

☐ Other: [________________________________]

☐ Other: [________________________________]

Total number of pages served: [____]

III. METHOD OF SERVICE

(Check all that apply and complete the corresponding section below.)

☐ A. Personal Service (In-Hand Delivery) (CR 4.04(2))

☐ B. Certified Mail, Return Receipt Requested (CR 4.01(1)(a))

☐ C. Registered Mail (CR 4.01(1)(a))

☐ D. Substitute Service at Usual Place of Abode (CR 4.04(2))

☐ E. Service on Authorized Agent / Registered Agent (CR 4.04(3)-(5))

☐ F. Service via Secretary of State (KRS § 454.210; KRS § 14A.4-040)

☐ G. Service by Warning Order (CR 4.05)

☐ H. Waiver / Acceptance of Service

A. PERSONAL SERVICE (IN-HAND DELIVERY)

I personally delivered true and correct copies of the Documents to:

Name of person served: [________________________________]

Date of service: [__/__/____]

Time of service: [____] ☐ a.m. ☐ p.m.

Address where service was made: [________________________________]

City, State, ZIP: [________________________________]

Physical description of person served:

• Gender: [________________________________]
• Approximate age: [____]
• Height: [____]
• Weight: [____]
• Hair color: [________________________________]
• Other distinguishing features: [________________________________]

The person served is:
☐ The named defendant
☐ An officer of the defendant corporation: [________________________________]
☐ A managing agent of the defendant entity: [________________________________]
☐ An agent authorized by appointment or law to receive service
☐ Other (describe): [________________________________]

B. CERTIFIED MAIL, RETURN RECEIPT REQUESTED

On [__/__/____], the clerk or I placed true and correct copies of the Documents in a sealed envelope, properly addressed to:

Name: [________________________________]

Address: [________________________________]

City, State, ZIP: [________________________________]

Said envelope was sent via certified mail, return receipt requested, with instructions to the delivering postal employee to deliver to the addressee only, as required by CR 4.01(1)(a).

Certified Mail Article Number: [________________________________]

Return receipt received: ☐ Yes ☐ No

Date signed on return receipt: [__/__/____]

Signature on return receipt by: [________________________________]

☐ Return receipt ("green card") is attached hereto as Exhibit [____].

C. REGISTERED MAIL

On [__/__/____], the Documents were sent via registered mail, return receipt requested, to:

Name: [________________________________]

Address: [________________________________]

Registered Mail Number: [________________________________]

☐ Return receipt is attached as Exhibit [____].

D. SUBSTITUTE SERVICE AT USUAL PLACE OF ABODE

On [__/__/____] at [____] ☐ a.m. ☐ p.m., I left true and correct copies of the Documents at the defendant's usual place of abode located at:

Address: [________________________________]

with [________________________________], a person of suitable age and discretion then residing therein.

Relationship to defendant: [________________________________]

Approximate age of person accepting service: [____]

Physical description of person accepting service:

• Gender: [________________________________]
• Approximate age: [____]
• Height: [____]
• Weight: [____]
• Hair color: [________________________________]

☐ I confirmed that this is the defendant's usual place of abode.
☐ I thereafter mailed a copy to the defendant at the same address by first-class mail on [__/__/____].

E. SERVICE ON AUTHORIZED AGENT / REGISTERED AGENT

I delivered the Documents to:

Name of agent: [________________________________]

Title/Position: [________________________________]

The agent is authorized to accept service on behalf of:

Name of entity/defendant: [________________________________]

Type of entity: ☐ Corporation ☐ LLC ☐ Partnership ☐ Other: [________________________________]

Date: [__/__/____] Time: [____] ☐ a.m. ☐ p.m.

Address where served: [________________________________]

F. SERVICE VIA KENTUCKY SECRETARY OF STATE

Pursuant to KRS § 454.210 (long-arm statute) or KRS § 14A.4-040, service was made on the Kentucky Secretary of State as statutory agent for:

Name of defendant/entity: [________________________________]

Date served on Secretary of State: [__/__/____]

☐ Fee of $[____] was paid.
☐ Certified mail copy was also sent to the defendant at their last-known address: [________________________________] on [__/__/____].

G. SERVICE BY WARNING ORDER (CR 4.05)

A Warning Order was entered on [__/__/____] because:

☐ Defendant is a nonresident absent from the state

☐ Defendant is a corporation/entity with no agent in the state

☐ Defendant has been absent from the state for four or more months

☐ Defendant has left the county or concealed themselves to avoid service

☐ Defendant's name or residence is unknown

Warning Order Attorney appointed: [________________________________]

Date of appointment: [__/__/____]

Defendant was warned to appear within 50 days from the date of the order.

☐ Publication was made in [________________________________] (newspaper) for [____] consecutive weeks.

☐ Warning Order Attorney's report is attached as Exhibit [____].

H. WAIVER / ACCEPTANCE OF SERVICE

[________________________________] acknowledged and accepted service of the Documents on [__/__/____].

☐ Signed waiver/acceptance is attached as Exhibit [____].

IV. PRIOR SERVICE ATTEMPTS AND DUE DILIGENCE

Additional due diligence efforts:

☐ Searched Kentucky Secretary of State records for registered agent information

☐ Searched public records for current address

☐ Contacted neighbors or other known associates

☐ Checked Kentucky Court of Justice records

☐ Other: [________________________________]

V. NON-SERVICE AFFIDAVIT

(Complete ONLY if service was NOT accomplished.)

☐ I was unable to serve the Documents on [________________________________] despite the following diligent efforts:

[________________________________]

[________________________________]

Reason service could not be completed:

☐ Defendant could not be located at the address provided

☐ Defendant has moved from the address provided

☐ Defendant is evading service

☐ Address is vacant or abandoned

☐ Defendant is incarcerated at [________________________________]

☐ Certified mail was returned unclaimed/refused

☐ Other: [________________________________]

VI. TIMELINESS OF SERVICE

Under CR 4.01(1)(a), the clerk shall place a copy of the summons and complaint in the mail as certified mail within a reasonable time. Under CR 4.06, the return of summons shall be made promptly and in no event later than the date on which the defendant's time for response expires.

Date complaint filed: [__/__/____]

Date service accomplished: [__/__/____]

☐ Service was timely accomplished.

☐ Service was not timely accomplished. A motion for extension or new summons was filed on [__/__/____].

VII. SERVICE FEES AND COSTS

Service fee: $[________________________________]

Mileage: [____] miles at $[____] per mile = $[________________________________]

Certified mail/postage costs: $[________________________________]

Other costs (describe): [________________________________] = $[________________________________]

Total: $[________________________________]

VIII. VERIFICATION AND OATH

I, [________________________________], declare under penalty of perjury under the laws of the Commonwealth of Kentucky that the foregoing is true and correct to the best of my knowledge, information, and belief.

Service was performed in full compliance with the Kentucky Rules of Civil Procedure (CR 4.01–4.06) and all applicable Kentucky statutes, local rules, and court orders.

I am competent to testify to the matters stated herein and will appear in court if subpoenaed.

IX. SIGNATURE AND NOTARIZATION

Executed on this [____] day of [________________________________], 20[____].

________________________________________
Signature of Affiant

Printed Name: [________________________________]
Business Address: [________________________________]
Telephone: [________________________________]

JURAT / NOTARY ACKNOWLEDGMENT

Commonwealth of Kentucky )
) ss.
County of [________________________________] )

Subscribed, sworn to, and acknowledged before me by [________________________________] on this [____] day of [________________________________], 20[____], to certify which witness my hand and official seal.

________________________________________
Notary Public, Commonwealth of Kentucky

Printed Name: [________________________________]
Commission Number: [________________________________]
My Commission Expires: [__/__/____]

[NOTARIAL SEAL]

X. CERTIFICATE OF FILING

I hereby certify that the original of this Affidavit of Service was filed with the Clerk of the Court on [__/__/____] and that a true and correct copy was served upon all counsel of record via:

☐ Hand delivery
☐ U.S. Mail, postage prepaid
☐ Electronic filing/service
☐ Other: [________________________________]

on [__/__/____].

________________________________________
Signature

XI. EXHIBITS

☐ Exhibit A — Court Order Appointing Special Bailiff (if applicable)

☐ Exhibit B — USPS Return Receipt ("Green Card") — Certified/Registered Mail

☐ Exhibit C — Signed Acknowledgment of Receipt

☐ Exhibit D — Warning Order Attorney Report

☐ Exhibit E — Proof of Publication

☐ Exhibit F — Photographs / GPS Records

☐ Exhibit G — Other: [________________________________]

KENTUCKY-SPECIFIC SERVICE RULES — QUICK REFERENCE

XII. FILING INSTRUCTIONS

1. Return of Service Filing: Under CR 4.06, the return of summons must be filed with the court promptly and in no event later than the date on which the defendant's time for response expires. Prompt filing is critical to avoiding dismissal for want of prosecution.

2. Certified Mail — Clerk's Role: Under CR 4.01(1)(a), it is typically the clerk (not the process server) who places certified mail in the postal system. The affidavit in this case should reflect the date the clerk mailed the summons and the receipt of the return receipt by the clerk. File the original return receipt with the court.

3. Special Bailiff Requirement: Under CR 4.02, a private process server must be appointed as a "special bailiff" by court order. Ensure the order is attached as an exhibit whenever a special bailiff serves process.

4. Warning Order — 50-Day Window: Under CR 4.05, once a warning order is entered, the defendant has 50 days from the date of the order to appear. A Warning Order Attorney must be appointed, who must attempt to notify the defendant and report to the court.

5. Long-Arm Service: For nonresident defendants under KRS § 454.210, service through the Kentucky Secretary of State requires payment of the statutory fee and mailing a copy to the defendant's last-known address by certified mail.

6. Multiple Defendants: Use a separate Affidavit/Return of Service for each defendant.

7. Electronic Filing: The Kentucky Court of Justice uses the eFiling system at https://www.kycourts.gov for online filing in eligible courts.

SOURCES AND REFERENCES

• Kentucky Rules of Civil Procedure, CR 4.01–4.07: https://www.kycourts.gov
• CR 4.01 — Summons; issuance; certified mail service by clerk
• CR 4.02 — Service by sheriff, constable, or appointed special bailiff
• CR 4.04 — Personal service, substitute service, entity service methods
• CR 4.05 — Warning order; nonresident defendants; 50-day appearance window
• CR 4.06 — Return of summons; proof of service requirements
• KRS § 454.210 — Kentucky Long-Arm Statute
• KRS § 14A.4-040 — Service on business entities through Secretary of State
• KRS § 425.046 — Sheriff service fees
• Kentucky Court of Justice: https://www.kycourts.gov
• Kentucky Secretary of State — Business Entity Search: https://sos.ky.gov/bus/BusinessSearch
• Kentucky Circuit Court Clerks' Manual (February 2026): https://www.kycourts.gov/Courts/County-Information/Documents/ClerksManual.pdf

This template is provided for informational purposes only. It does not constitute legal advice and should not be used as a substitute for consultation with a qualified attorney licensed in Kentucky. All service of process must comply with the current version of the Kentucky Rules of Civil Procedure and any applicable local rules or court orders.

DISCLAIMER: This template is provided for informational purposes only and does not constitute legal advice. Consult a licensed attorney before use.