AFFIDAVIT OF SERVICE
(State of West Virginia)
[// GUIDANCE: This template is drafted to comply with Rule 4 of the West Virginia Rules of Civil Procedure (“W. Va. R. Civ. P.”). Bracketed fields MUST be completed or deleted before filing. Remove all guidance comments in final execution copy.]
TABLE OF CONTENTS
- Document Header
- Definitions
- Operative Provisions (Affiant Statements)
- Representations & Warranties
- General Provisions
- Execution Block
- Notary Acknowledgment
- Annex A – Service Method Checklist
1. DOCUMENT HEADER
Affidavit Title: Affidavit of Service of [DESCRIPTION OF DOCUMENT(S)]
Court: [__ Court of __ County, West Virginia]
Civil Action No.: [_____]
Plaintiff(s): [_____]
Defendant(s): [_____]
Effective Date: [DATE OF EXECUTION]
Governing Law / Forum: State of West Virginia; subject to Rule 4, W. Va. R. Civ. P.
2. DEFINITIONS
For purposes of this Affidavit, the following capitalized terms shall have the meanings set forth below:
2.1 “Affiant” means the natural person executing this Affidavit.
2.2 “Case” means the civil action identified in the Document Header.
2.3 “Documents” means [list each pleading, summons, subpoena, notice, or other paper served].
2.4 “Method of Service” means the manner in which service was effected, selected from the options permitted under Rule 4, W. Va. R. Civ. P., as further detailed in Annex A.
2.5 “Service Address” means [street address, city, state, zip code] at which service was attempted or effected.
2.6 “Service Date” means [MM/DD/YYYY], the calendar date on which service of the Documents was completed.
3. OPERATIVE PROVISIONS (AFFIANT STATEMENTS)
The Affiant, being first duly sworn, deposes and states as follows:
3.1 Identity & Capacity.
(a) My full legal name is [AFFIANT NAME]; I am [age] years of age.
(b) My address is [AFFIANT STREET ADDRESS, CITY, STATE, ZIP].
(c) I am ☐ a sheriff/deputy sheriff ☐ a private process server ☐ an individual adult who is not a party to nor interested in this Case, duly authorized under Rule 4(c), W. Va. R. Civ. P., to serve civil process in West Virginia.
3.2 Documents Served.
On the Service Date, I served the Documents described in Section 2.3.
3.3 Method & Manner of Service.
(a) I effected service by the Method of Service checked and further described in Annex A.
(b) If service was made by personal delivery: I personally delivered true copies of the Documents to [NAME OF PERSON SERVED], a person to be served under Rule 4(f).
(c) If service was made by substitute service:
(i) I first exercised due diligence to effect personal service, making [NUMBER] separate attempts as detailed in Annex A; and
(ii) I thereafter left the Documents [with a person of suitable age at the usual abode / at the usual place of business / as otherwise permitted] under Rule 4(d) & (f).
(d) If service was made by certified mail: I caused the Documents to be mailed via certified mail, return receipt requested, as evidenced by the attached signed green card or USPS electronic receipt (Exhibit 1).
3.4 Timing Compliance.
Service was completed within the time period required by Rule 4(k), W. Va. R. Civ. P., namely [number] days after issuance of the summons.
3.5 Accuracy.
All statements herein are based on my personal knowledge and are true and correct to the best of my information, knowledge, and belief.
4. REPRESENTATIONS & WARRANTIES
4.1 No Party Interest. Affiant represents that Affiant is not a party to, nor financially interested in, the outcome of the Case.
4.2 Competence. Affiant is legally competent to make this Affidavit and capable of testifying to the matters stated herein.
4.3 Compliance Warranty. Affiant warrants that service was performed in strict conformity with all applicable provisions of Rule 4, W. Va. R. Civ. P., any governing local rules, and any specific court orders in the Case.
4.4 Survival. The representations and warranties set forth in this Affidavit shall survive its filing and may be relied upon by the Court and all parties to the Case.
5. GENERAL PROVISIONS
5.1 Amendments. If any factual error is later discovered, Affiant shall promptly file an Amended Affidavit of Service.
5.2 Severability. If any portion of this Affidavit is determined invalid, the remainder shall remain in full force and effect.
6. EXECUTION BLOCK
Executed on this ___ day of [Month] [Year] at [City], West Virginia.
[NAME OF AFFIANT]
Affiant
7. NOTARY ACKNOWLEDGMENT
(Use West Virginia short-form acknowledgment under W. Va. Code § 39-4-12.)
State of West Virginia )
County of ______ ) ss:
On this ___ day of [Month] [Year], 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.
Witness my hand and official seal.
Notary Public
My Commission Expires: ______
Notary Seal:
8. ANNEX A – SERVICE METHOD CHECKLIST
[// GUIDANCE: Select/complete only the applicable subsection(s); delete inapplicable items.]
A-1. ☐ Personal Service (Rule 4(d)(1), (f)(1))
Name of individual served: ____
Date & time: __ @ __ a.m./p.m.
Location (full address): __________
A-2. ☐ Substitute Service at Dwelling (Rule 4(d)(1), (f)(1)(B))
Name & relationship of recipient: ____
Attempts at personal service (dates/times):
1. _ 2. _ 3. __
Location of substitute service: ______
Reason personal service impracticable: ____
A-3. ☐ Certified Mail (Rule 4(d)(1)(D))
USPS Tracking No.: _____
Date of mailing: ___ Date delivered: _____
Return receipt attached as Exhibit 1 ☐
A-4. ☐ Service on Business Entity (Rule 4(d)(5))
Entity name: ______
Recipient’s capacity (e.g., registered agent/officer): __
Method: ☐ Personal ☐ Certified Mail ☐ Other: _
A-5. ☐ Service Accepted/Waived (Rule 4(d)(8))
Signed Acceptance of Service attached as Exhibit 2 ☐
[// GUIDANCE: End of template. Double-check that all bracketed placeholders are completed, that a copy of the served documents, any USPS receipts, or acceptance/waiver forms are attached as exhibits, and that the executed affidavit is filed promptly with the clerk in compliance with local rules.]