AFFIDAVIT OF SERVICE

State of Vermont )
) ss.
County of [COUNTY] )

TABLE OF CONTENTS

I. Document Header
II. Definitions
III. Operative Provisions
IV. Representations & Warranties
V. Covenants & Restrictions
VI. Default & Remedies
VII. Risk Allocation
VIII. Dispute Resolution
IX. General Provisions
X. Execution Block

[// GUIDANCE: Because a Service Affidavit is fundamentally an evidentiary statement—not a bilateral contract—many traditional contract sections are shortened or marked “Intentionally Omitted.” They are preserved here to conform with the client-requested architecture and to facilitate any future expansion (e.g., converting this form for use in retained-process-server agreements).]

I. DOCUMENT HEADER

1. Title. Affidavit of Service (the “Affidavit”).
2. Deponent. [PROCESS SERVER FULL LEGAL NAME] (the “Process Server”).
3. Served Party. [NAME OF PARTY SERVED] (the “Served Party”).
4. Underlying Action. [CAPTION OF LAWSUIT OR PROCEEDING], Docket No. [DOCKET #], pending in the [NAME OF COURT], State of Vermont.
5. Effective Date. This Affidavit is effective as of the date of notarization below (the “Effective Date”).
6. Governing Law. This Affidavit is governed by the procedural law of the State of Vermont, including Vt. R. Civ. P. 4.

II. DEFINITIONS

“Documents” means the legal papers listed in Section III.2.
“Service Date” means the calendar date on which physical delivery, mailing, or substituted service occurred, as stated in Section III.3.
“Manner of Service” means the authorized method(s) selected in Section III.3.
“Substituted Service” has the meaning given in Vt. R. Civ. P. 4(d)–(h) (service at dwelling, on an authorized agent, etc.).

III. OPERATIVE PROVISIONS

1. Capacity of Process Server.
   The Process Server affirms that he/she is (i) at least 18 years of age, (ii) competent to testify, and (iii) not a party to the above-captioned action.

2. Documents Served.
   • [SUMMONS]
   • [COMPLAINT]
   • [MOTION / ORDER / SUBPOENA / OTHER]
   (collectively, the “Documents”).

3. Service Details.
   a. Service Date: [MM/DD/YYYY] at [TIME].
   b. Location: [FULL STREET ADDRESS, CITY, VT ZIP].
   c. Manner of Service (check all that apply):
   ☐ Personal delivery to the Served Party.
   ☐ Substituted Service at the Served Party’s usual place of abode by leaving the Documents with [NAME], a person of suitable age and discretion, and mailing a copy to the same address.
   ☐ Service upon an agent authorized by appointment or by law to receive service, namely [REGISTERED AGENT/ATTORNEY NAME].
   ☐ Certified/registered mail, return receipt requested, in compliance with Vt. R. Civ. P. 4(l)(2).
   ☐ Other (describe): [DESCRIPTION].

4. Description of Individual Served (if personal or substituted):
   • Sex: [ ] • Approx. Age: [ ] • Height: [ ] • Weight: [ ]
   • Hair Color: [ ] • Other Identifying Features/Attire: [ ]

5. Timing Compliance.
   Service was effected within the time limits prescribed by Vt. R. Civ. P. 3 and 4 (i.e., within 60 days after filing and within any court-ordered extension).

6. Fees and Mileage (if sought to be taxed as costs).
   The Process Server’s statutory fee: $[AMOUNT]; mileage: [MILES] @ $[RATE] per mile; total: $[TOTAL].

IV. REPRESENTATIONS & WARRANTIES

1. Truthfulness. The Process Server represents and warrants that all statements herein are true and correct to the best of his/her personal knowledge, information, and belief, and that falsification is subject to the penalties of perjury under Vermont law.
2. Compliance with Rule 4. The Process Server further represents that service was effected strictly in accordance with Vt. R. Civ. P. 4 and any applicable court order.
3. Independence. The Process Server is not an employee or relative of any party, thereby avoiding disqualifying conflicts.

V. COVENANTS & RESTRICTIONS

(The nature of an affidavit leaves no ongoing covenants. Section intentionally limited.)

VI. DEFAULT & REMEDIES

(Non-applicable; no contractual performance obligations are created. False statements remain subject to criminal penalties for perjury and contempt powers of the court.)

VII. RISK ALLOCATION

(Indemnification and liability caps are not applicable. Any challenge to service will be adjudicated under Vermont procedural rules.)

VIII. DISPUTE RESOLUTION

1. Governing Law. Vermont procedural law, including Vt. R. Civ. P. 4, governs any dispute regarding the sufficiency or proof of service.
2. Forum Selection. Any motion contesting this Affidavit shall be filed in the court where the underlying action is pending.
3. Arbitration / Jury Waiver / Injunctive Relief. Not applicable.

IX. GENERAL PROVISIONS

1. Severability. If any statement herein is found legally defective, the remaining statements shall remain valid to the fullest extent permitted.
2. Counterparts; Electronic Signatures. This Affidavit may be executed in identical counterparts or via electronic signature permitted under Vermont law.

X. EXECUTION BLOCK

I, [PROCESS SERVER NAME], being first duly sworn, depose and say that I have read the foregoing Affidavit, know the contents thereof, and declare under oath that the statements made are true and correct.

[PROCESS SERVER NAME]
Process Server

Date: ________

Notarial Certificate

State of Vermont, County of [COUNTY], ss.

On this _ day of _____, 20__, before me, the undersigned notary public, personally appeared [PROCESS SERVER NAME], known to me (or satisfactorily proven) to be the person whose name is subscribed to this instrument, and acknowledged that he/she executed the same for the purposes therein contained.

Notary Public
Printed Name: ___
Commission Number: ____
My Commission Expires: ___

[// GUIDANCE:
1. Attach the postal “green card” or electronic delivery confirmation if service was by certified mail.
2. For corporations, list the statute-authorized agent in Section III.3.c and include the agent’s title.
3. When substituted service is used, always mail a copy on the same day or next business day and record the tracking number.
4. File the completed, notarized Affidavit promptly with the clerk to create the official proof-of-service record under Vt. R. Civ. P. 4(l).]