STATE OF NORTH CAROLINA IN THE GENERAL COURT OF JUSTICE
[COUNTY] COUNTY ☐ SUPERIOR ☐ DISTRICT COURT DIVISION
File No.: [______]
[PLAINTIFF NAME], )
)
Plaintiff, )
)
v. ) AFFIDAVIT OF SERVICE
)
[DEFENDANT NAME], )
)
Defendant. )
__________)
TABLE OF CONTENTS
- Definitions
- Operative Provisions (Affidavit Statements)
- Representations & Warranties of Affiant
- General Provisions
- Execution & Notarial Certification
[// GUIDANCE: Delete the Table of Contents if court-rules or local practice prohibit it.]
1. Definitions
For purposes of this Affidavit of Service (the “Affidavit”), capitalized terms have the meanings set forth below.
1.1 “Affiant” means the individual executing this Affidavit who effected service of the Document(s) Served.
1.2 “Document(s) Served” means the pleading(s), motion(s), summons, notice(s), or other paper(s) identified in Section 2.2 and delivered pursuant to Rule 4 of the North Carolina Rules of Civil Procedure (“N.C. R. Civ. P.”).
1.3 “Personal Service” has the meaning provided in N.C. Gen. Stat. § 1A-1, Rule 4(j)(1)a—i.e., delivery to the person to be served.
1.4 “Substitute Service” has the meaning provided in N.C. Gen. Stat. § 1A-1, Rule 4(j)(1)b—i.e., delivery at the defendant’s usual place of abode to a person of suitable age and discretion then residing therein.
1.5 “Service Date” means the calendar date on which the Document(s) Served were delivered as set forth in Section 2.4.
2. Operative Provisions (Affidavit Statements)
I, [AFFIANT NAME], being duly sworn, depose and say:
2.1 Competency. I am over the age of 21, competent to testify to the matters stated herein, and am not a party to the above-captioned action.
2.2 Identification of Document(s) Served. On the Service Date, I served the following document(s):
• [Specify each document—e.g., “Civil Summons,” “Verified Complaint,” etc.]
2.3 Person/Entity Served.
a. Name of person or entity served: [______]
b. Capacity (if any): ☐ Defendant ☐ Registered Agent ☐ Other [specify]
2.4 Manner, Date, Time, and Location of Service.
a. ☐ Personal Service ☐ Substitute Service ☐ Certified Mail ☐ Designated Delivery Service ☐ Other [specify]
b. Service Date: [MM/DD/YYYY]
c. Time of Service: [HH:MM ☐ a.m. ☐ p.m.]
d. Physical address where service was effected: [Street, City, State, ZIP]
2.5 Substitute Service Particulars (complete only if box checked in § 2.4a).
a. Name of person served: [___]
b. Relationship to Defendant: [___]
c. Confirmation that the individual is of suitable age and discretion and resides at Defendant’s usual place of abode.
2.6 Additional Attempts (if applicable). Prior to successful service, I made the following unsuccessful attempts:
• Attempt #1 on [date] at [time]—[result]
• Attempt #2 on [date] at [time]—[result]
2.7 Compliance Statement. Service was completed in accordance with N.C. Gen. Stat. § 1A-1, Rule 4, and within the time limits prescribed by Rule 4(c) (60-day period for service of summons) or other applicable rule.
2.8 Fee for Service (optional). Amount charged for service: $[__].
3. Representations & Warranties of Affiant
3.1 Accuracy. All statements in this Affidavit are true and correct to the best of my knowledge, information, and belief.
3.2 Disinterestedness. I am not a party, nor am I related by blood or marriage to any party named in the above-captioned action.
3.3 No Military Status (optional, but recommended for default matters). Based on reasonable inquiry, the individual served is not in the active military service of the United States as defined in the Servicemembers Civil Relief Act, 50 U.S.C. § 3931.
[// GUIDANCE: Omit § 3.3 if military status averment is not needed for your particular filing.]
4. General Provisions
4.1 Severability. If any provision of this Affidavit is held invalid or unenforceable, the remaining provisions shall remain in full force and effect.
4.2 Governing Law. This Affidavit shall be governed by and construed in accordance with the laws of the State of North Carolina, without regard to its conflict-of-laws rules.
4.3 Filing & Service of Affidavit. A copy of this executed Affidavit, together with the original return receipt (if service by mail) or other proof of delivery, shall be promptly filed with the Clerk of Court and served on all parties of record as required by N.C. R. Civ. P. 5.
[// GUIDANCE: Section 4 contains boilerplate provisions that, while not strictly required for an affidavit, help preserve enforceability and reduce challenges to form.]
5. Execution & Notarial Certification
I certify under penalty of perjury that the foregoing is true and correct.
Dated: _ day of _, 20____.
[AFFIANT NAME]
Address: [____]
Phone: [--_]
Email: [_________]
Notarial Acknowledgment (North Carolina)
State of North Carolina
County of ___
On this _ day of _, 20____, before me, the undersigned notary public, personally appeared [AFFIANT NAME], known to me or satisfactorily proven to be the person whose name is subscribed to the foregoing Affidavit of Service, and acknowledged that he/she executed the same for the purposes therein contained.
☐ Personally Known ☐ Produced Identification (Type: ______)
Notary Public Signature
Notary Public Printed Name: ____
My Commission Expires: _//_
(Official Notarial Seal)
[// GUIDANCE:
1. File the original Affidavit (with any required attachments) promptly after service.
2. Attach the return receipt or delivery confirmation when service is by certified mail or designated delivery service.
3. For substitute service, confirm that the person served meets the “suitable age and discretion” standard and resides at the defendant’s abode.
4. Local rules may impose additional formatting or cover-sheet requirements—verify with the clerk before filing.
]