IN THE COUNTY COURT OF POLK COUNTY, FLORIDA
CASE NO. _________________
AFFIDAVIT OF SERVICE
BEFORE ME, the undersigned authority, personally appeared _______________, who, after being first duly sworn, deposes and says as follows:
1. That he is over the age of eighteen and is not a party to the litigation which is the subject matter of the above-styled cause of action.
2. That he received this process on the _____ day of ___________, 19____ and served same on the defendant on the _____ day of _________, 19___ at ________ .M. by serving a copy on _________________________________.
3. That he is disinterested in this process that he has served.
SWORN TO and subscribed before me this _____ day of ________, 19___.
_______________________________________ ____ Personall Known
Type of identification presented:_____________________
My Commission Expires:
REV. 06/97 126.doc (06/97)