AFFIDAVIT OF SERVICE

[IN THE ___ COURT FOR ___ COUNTY, TENNESSEE]
[Style of Case]
Docket No.: [___]

I. DOCUMENT HEADER

1. Affiant Identification
   I, [FULL LEGAL NAME OF PROCESS SERVER OR OTHER PERSON MAKING SERVICE] (“Affiant”), being duly sworn, depose and state as follows under penalty of perjury pursuant to Tenn. Code Ann. §§ 39-16-702 & -703 (false statements in sworn documents):

2. Effective Date & Jurisdiction
   This Affidavit of Service (the “Affidavit”) is executed on [DATE], in the State of Tennessee and is governed by the Tennessee Rules of Civil Procedure (“Tenn. R. Civ. P.”) and applicable local rules of this Court.

[// GUIDANCE: Insert the exact court caption, including judicial district, to comply with Tenn. R. Civ. P. 10.01 formatting requirements.]

II. DEFINITIONS

For purposes of this Affidavit, the following capitalized terms shall have the meanings set forth below:

“Document(s)” – The pleading(s), subpoena(s), notice(s), writ(s), or other legal paper(s) required to be served in this action.
“Method of Service” – The legally authorized means by which service was accomplished, as delineated in Tenn. R. Civ. P. 4.04.
“Service Date” – The calendar date on which actual delivery constituting valid service occurred.
“Subject Recipient” – The person or entity upon whom service was required and purportedly effected.

[// GUIDANCE: Delete, add, or revise definitions to match the particular papers served.]

III. OPERATIVE PROVISIONS (STATEMENTS OF SERVICE)

3. Documents Served
   The Document(s) served consisted of:
   • [Summons]
   • [Complaint]
   • [Subpoena]
   • [Other: ______]

4. Subject Recipient
   The Document(s) were directed to [NAME OF DEFENDANT/RESPONDENT; OR CORPORATE AGENT] at the following address:
   [STREET ADDRESS, CITY, STATE, ZIP].

5. Method of Service
   Service was effected in compliance with Tenn. R. Civ. P. 4.04 by the following Method of Service (check and complete all that apply):

⬜ Personal delivery to the Subject Recipient.
⬜ Leave with [NAME / RELATION], a person of suitable age and discretion residing at the Subject Recipient’s usual place of abode.
⬜ Delivery to [NAME], designated agent for service of process for [ENTITY].
⬜ Certified mail, return receipt requested, restricted delivery; green card signed by [NAME] on [DATE].
⬜ Substitute service on spouse ( see Tenn. R. Civ. P. 4.04(1)), i.e., [NAME OF SPOUSE] residing at the same abode.
⬜ Other court-authorized method (describe): ______.

6. Service Date & Time
   Service was completed on [DATE] at [TIME] [AM/PM].

7. Compliance With Timing Requirements
   The Document(s) were served within ninety (90) days after issuance of the accompanying summons, as mandated by Tenn. R. Civ. P. 4.01(3), or within any extension granted by the Court.

8. Attempts & Due Diligence (if applicable)
   Prior attempts to serve were made on:**
   • [DATE / TIME / ADDRESS] – unsuccessful (reason)
   • [DATE / TIME / ADDRESS] – unsuccessful (reason)

[// GUIDANCE: Courts frequently inquire into diligence when substitute service is used. Record at least two (2) good-faith attempts before resorting to substitute methods.]

IV. REPRESENTATIONS & WARRANTIES (AFFIANT’S OATH)

9. Affiant’s Competence
   a. I am over the age of eighteen (18) and not a party to or otherwise interested in this action.
   b. I am authorized to serve process under Tenn. R. Civ. P. 4.01(2) and applicable local rules.

10. Truthfulness & Completeness
    I declare under oath that the foregoing statements are true and correct to the best of my knowledge, information, and belief.

11. Record Preservation
    I have retained copies of all proofs of delivery, certified mail receipts, and contemporaneous notes relating to each attempt at service and will produce them upon request of the Court or any party.

V. COVENANTS & RESTRICTIONS

12. Continued Cooperation
    Affiant shall, upon reasonable notice, appear in Court and testify regarding the facts set forth herein and shall update this Affidavit if any material misstatement is discovered.

VI. DEFAULT & REMEDIES

13. Consequences of False Statement
    Any intentional falsification herein subjects Affiant to prosecution for perjury (Class A misdemeanor) and potential civil sanctions, including but not limited to contempt of court.

VII. RISK ALLOCATION

(Not Applicable – no contractual risk allocation between parties is implicated by a service affidavit.)

VIII. DISPUTE RESOLUTION

(See Tenn. R. Civ. P. 4.01–4.07 for any challenges to service. No separate arbitration or forum clause is necessary.)

IX. GENERAL PROVISIONS

14. Severability
    If any portion of this Affidavit is deemed invalid or unenforceable, the remaining portions shall remain in full force and effect.

15. Integration
    This Affidavit constitutes the entire proof of service intended for filing in this action; no prior oral or written statement shall modify its terms.

X. EXECUTION BLOCK

State of Tennessee )
County of [__] )

Subscribed and sworn to (or affirmed) before me by [AFFIANT NAME] on this ___ day of [MONTH], 20__.

Notary Public

My Commission Expires: __

Signature of Affiant

Print Name: ____
Process Server Registration/Badge No. (if any): _
Address: ___
Telephone: ____

[// GUIDANCE: 1) Attach the certified-mail “green card,” if applicable, behind this Affidavit.
2) File the original Affidavit with the clerk and serve a copy on all counsel of record as required by Tenn. R. Civ. P. 5.02.
3) Use the local notarial certificate prescribed by Tenn. Code Ann. § 66-22-110 if the county clerk requires a specific form.]