CIRCUIT COURT FOR , MARYLAND
Located at Case No.
vs
.
AFFIDAVIT OF SERVICE
(Certified Mail Restricted Delivery – Receipt Requested)
(Md. Rule 2-121)
NOTE: This form provides proof to the court that copies of documents filed in the above case by one
party have been delivered to the other party. Complete this form if you mailed one party’s court
documents to the other party. Complete ALL blanks and attach the original return receipt (green card).
The court may determine that proper service was NOT made if someone other than the opposing party
signs the original receipt.
On , at , I served, by
certified mail, restricted delivery, return receipt requested, .
I have attached the original return receipt.
I certify that I am over the age of 18 and I am NOT the plaintiff or the defendant. I served the documents
checked below.
Check all that apply:
☐ Writ of Summons
☐ Complaint/Petition/Motion
☐ Domestic Case Information Report (form CC-DCM-001)
☐ Financial Statement
☐ Show Cause Order and Petition
☐ Other (list all other documents served):
AFFIDAVIT
I solemnly affirm under penalties of perjury that the contents of this document are true to the best of my
knowledge, information, and belief.
CC-DR
-056 (Rev. 04/2021)
City/County
Court Address
Defendant
Plaintiff
Address
Address
City, State, Zip
Telephone
City, State, Zip
Telephone
Date
Address
Name of opposing party
Issue date of the summons for the complaint/petition/motion listed below
Name of complaint/petition/motion
Type of petition
Signature
Telephone Number
Fax
E-mail
Date
Printed Name
Address
City, State, Zip
Reset
