APS# *
Job Number
Code *
Zone is in front of Name
Service for (Name) *
Service for (Name)
Date Served *
Date Served
Time Served *
Time Served
Address Served *
Type Street Number
Service Type *
Service Type
Person Served Name *
Person Served Name
Relationship/Title *
Residency Confirmed *
This is for Substitute Service, select Personal Service is you served it in Person.
Description *
Driver's License Confirmed *
Driver's License Confirmed or NA
Contact Phone# *
Contact Phone# or NA
Tag Numbers *
Tag Numbers or NA
Acceptance Form Signed *
Acceptance Form Signed
Service Rate *
Details *
Sworn Statement
Process Servers Electronic Signature *
Process Servers Name
License Number *
License Number or NA if unknown
Date Reported *
Date Reported
Photo of Person Served
Photo of Person Served
Photo Address Served
Photo Address Served
Photo Mailbox
Photo Mailbox
Photo Automobile
Photo Automobile
Photo Other
Photo Other
Affidavit Received *
Affidavit Received?