AFFIDAVIT OF SERVICE
(Pennsylvania – Proof of Service of Legal Documents)
[COURT CAPTION BLOCK]
Court of Common Pleas of [COUNTY] County, Pennsylvania
Civil Division
Docket No.: [DOCKET NUMBER]
TABLE OF CONTENTS
- Document Header
- Definitions
- Operative Provisions
- Representations & Warranties
- Covenants & Restrictions
- Default & Remedies
- Risk Allocation
- Dispute Resolution
- General Provisions
- Execution Block
[// GUIDANCE: A Table of Contents is included for ease of reference, although the document is brief. Omit if local practice prefers a shorter form.]
1. DOCUMENT HEADER
Affiant: [FULL LEGAL NAME]
Address: [ADDRESS]
Contact Number: [PHONE]
Email (optional): [EMAIL]
Effective Date of Affidavit: [DATE]
Governing Procedural Law: Pennsylvania Rules of Civil Procedure (Pa. R. Civ. P.).
Recitals
WHEREAS, the Affiant is over eighteen (18) years of age, competent to testify to the matters set forth herein, and is not a party to the above-captioned action; and
WHEREAS, the Affiant effected service of the Subject Documents in compliance with Pa. R. Civ. P. 400–405;
NOW, THEREFORE, the Affiant hereby makes this sworn Affidavit of Service.
2. DEFINITIONS
For purposes of this Affidavit, the following terms shall have the meanings set forth below:
“Affiant” – The individual executing this Affidavit of Service.
“Defendant” – [DEFENDANT NAME], the party upon whom service was intended.
“Original Process” – A writ of summons or complaint commencing a civil action, as defined in Pa. R. Civ. P. 400(a).
“Subject Documents” – The legal documents served, including but not limited to [list: Complaint, Writ of Summons, Motion, Subpoena, etc.].
“Service Address” – [FULL ADDRESS WHERE SERVICE OCCURRED].
“Service Date” – [MM/DD/YYYY].
“Service Method” – The authorized means by which the Subject Documents were delivered, selected from §3.1 below.
“Substitute Service” – Service accepted by a qualified third person pursuant to Pa. R. Civ. P. 402(a)(2).
3. OPERATIVE PROVISIONS
3.1 Statement of Service
The Affiant hereby states under penalty of perjury that on the Service Date at [TIME] A.M./P.M., the Affiant effected service of the Subject Documents upon the Defendant at the Service Address by the following method (check one):
☐ Personal service – delivery directly to Defendant (Pa. R. Civ. P. 402(a)(1)).
☐ Substitute service – left with [NAME], an adult in charge of Defendant’s residence, relationship: [RELATIONSHIP] (Pa. R. Civ. P. 402(a)(2)(i)).
☐ Substitute service – left with [NAME], manager/agent of Defendant’s usual place of business (Pa. R. Civ. P. 402(a)(2)(iii)).
☐ Certified mail, return-receipt requested, signed by Defendant (Pa. R. Civ. P. 403).
☐ Sheriff’s service (Pa. R. Civ. P. 400(b)).
☐ Other court-authorized method: [DESCRIBE] (Pa. R. Civ. P. 430).
[// GUIDANCE: Retain only the applicable checkbox; strike or delete unused options.]
3.2 Timing Compliance
Service was completed within the time period prescribed by Pa. R. Civ. P. 404 & 405, namely:
• Original process issued on [DATE] and served within 30 days thereafter; or
• Reissued/reelectron [DATE] and served within 30 days of reissuance; or
• As otherwise directed by court order dated [DATE].
3.3 Manner of Service Details
If service was by substitute service or certified mail, provide specifics:
• Physical description of recipient (for personal/substitute service): [HEIGHT/BUILD/GENDER/APPROX. AGE].
• USPS tracking number (if by mail): [TRACKING NUMBER].
• Return-receipt attached as Exhibit A.
• Court order authorizing special service attached as Exhibit B (if applicable).
3.4 Fees & Mileage
Total service fee received: $[AMOUNT]; Mileage: [MILES] @ $[RATE] = $[AMOUNT] (if applicable).
4. REPRESENTATIONS & WARRANTIES
4.1 Truthfulness. Affiant represents that all statements herein are true and correct to the best of Affiant’s knowledge, information, and belief.
4.2 Competency. Affiant is competent to testify and will testify to the matters stated herein if called as a witness.
4.3 Non-Interested Party. Affiant affirms that they are not a party to, or otherwise interested in, the outcome of this action.
[// GUIDANCE: These representations satisfy Pa. R. Civ. P. 405(b) requirements for a “return of service” and preserve admissibility.]
5. COVENANTS & RESTRICTIONS
5.1 Record Preservation. Affiant shall preserve all contemporaneous notes, photographs, GPS data, and receipts relating to service for no less than [__] years or until final disposition of this action, whichever is later.
5.2 Further Cooperation. Affiant agrees to appear for deposition, hearing, or trial testimony upon reasonable notice to authenticate or clarify the service effected.
6. DEFAULT & REMEDIES
6.1 Perjury Acknowledgment. Affiant understands that willfully false statements herein are punishable under 18 Pa. Cons. Stat. § 4902 (perjury) and may subject Affiant to criminal and civil liability.
6.2 Court-Ordered Sanctions. Failure to comply with §5 above may result in court-imposed sanctions, including but not limited to contempt or cost-shifting.
7. RISK ALLOCATION
(Not applicable – informational document only.)
8. DISPUTE RESOLUTION
8.1 Governing Law. This Affidavit shall be governed by and construed in accordance with the laws and procedural rules of the Commonwealth of Pennsylvania.
8.2 Forum Selection. Any dispute relating to the validity or sufficiency of this Affidavit shall be adjudicated exclusively in the Pennsylvania state court having jurisdiction over the underlying action.
9. GENERAL PROVISIONS
9.1 Amendments. This Affidavit may be amended only by a subsequent sworn statement of the Affiant or by court order.
9.2 Severability. If any provision herein is deemed unenforceable, the remaining provisions shall remain in full force to the extent permitted by law.
9.3 Integration. This Affidavit, including all exhibits hereto, constitutes the entire proof of service and supersedes any prior oral or written statements by the Affiant on this subject.
10. EXECUTION BLOCK
I, [FULL LEGAL NAME], the Affiant, do hereby affirm under penalty of perjury under the laws of the Commonwealth of Pennsylvania that the foregoing is true and correct.
Date: [DATE]
[AFFIANT SIGNATURE]
[PRINTED NAME]
JURAT – NOTARIAL ACKNOWLEDGMENT
Commonwealth of Pennsylvania )
: ss.
County of [COUNTY] )
On this [__] day of [MONTH], [YEAR], before me, the undersigned notary public, personally appeared [AFFIANT NAME], proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to this Affidavit, and acknowledged that they executed the same for the purposes therein contained.
Notary Public
My Commission Expires: [DATE]
Notarial Seal: _______
[// GUIDANCE: Pennsylvania requires a jurat (sworn statement) rather than an acknowledgment when the Affiant is swearing to the truth of the contents. Confirm local practice and modify accordingly.]
EXHIBITS
• Exhibit A – USPS Return-Receipt (if service by certified mail)
• Exhibit B – Court Order Authorizing Alternative Service (if applicable)
[// GUIDANCE: Attach only those exhibits relevant to the selected Service Method.]