Claimant’s Proof Of Service

Arbitration:*
Declaration*
I agree to declaration under penalty of perjury
I, the undersigned, declare under penalty of perjury under the laws of the United States of America that I am over 18 years of age and that on the date set forth below I served a true copy of the foregoing Claim upon the Respondent at the address below by (check one):
Check one:*
- Depositing it in first class U.S. mail, postage prepaid, addressed as below
- Delivering it by hand to the Respondent at the address below
- Other (describe below)
Other Description
Name of Respondent upon whom Claim was served:*
First Last
Address of Respondent upon whom Claim was served:*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Type Your Full Name:*
Executed at:*

City, State and Country
Dated:*
MM slash DD slash YYYY
Signature:*
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