COMMONWEALTH OF KENTUCKY

[COURT NAME]
[CIVIL ACTION NO. _____]

[PLAINTIFF NAME]
  Plaintiff,
v.
[DEFENDANT NAME]
  Defendant.

AFFIDAVIT OF SERVICE

(Prepared Pursuant to Kentucky Rules of Civil Procedure 4.01 – 4.06)

[// GUIDANCE: This template is designed for use in Kentucky state-court civil actions. Carefully review all placeholders and check-boxes before filing. Attach all referenced exhibits (e.g., USPS “green cards,” signed acknowledgments) to maximize evidentiary weight.]

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I. RECITALS

1. Affiant Identity. I, [AFFIANT NAME], am competent to testify, at least 18 years of age, and not a party to the above-captioned action.

2. Authority to Serve.
   ☐ Kentucky Sheriff/Deputy Sheriff of [COUNTY]
   ☐ Constable of [COUNTY]
   ☐ Court-appointed Special Bailiff / Private Process Server (Order dated _ attached as Exhibit A)
   ☐ Other: _______

3. Documents Served. The following pleadings or papers (collectively, the “Documents”) were delivered:
   • ______
   • ______

[// GUIDANCE: List each document exactly as captioned (e.g., “Summons and Verified Complaint”).]

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II. DEFINITIONS

For ease of reference, the following capitalized terms shall have the meanings set forth below:

“Action” means the civil proceeding identified in the caption above.
“Service Address” means the physical address, post office box, or statutory agent location at which service was attempted or effected.
“Service Date” means the calendar date on which the Documents were delivered or deemed delivered under applicable law.
“Service Method” has the meaning assigned in Section III.
“Substitute Recipient” means a person other than the named party who received the Documents as permitted under Ky. R. Civ. P. 4.04(2) & (3).

[// GUIDANCE: If the case involves multiple defendants or entities, consider defining each separately to avoid ambiguity.]

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III. OPERATIVE STATEMENTS OF SERVICE

1. Service Method. (Select and complete all that apply.)

☐ Personal Service (In-Hand). On the Service Date of //20__, at : ☐AM ☐PM, I personally delivered true copies of the Documents to [NAME OF PERSON SERVED] at [SERVICE ADDRESS].

☐ Certified Mail, Return Receipt Requested. On //20__, I deposited the Documents, properly enclosed and postage prepaid, in the United States Mail addressed to [NAME/ENTITY] at [SERVICE ADDRESS]. The USPS “green card” bearing Article No. ___ and executed on //20__ is attached as Exhibit ___.

☐ Registered Mail. (Details identical to Certified Mail; attach proof.)

☐ First-Class Mail with Acknowledgment Form. Acknowledgment executed on //20__ is attached as Exhibit ___.

☐ Substitute Service at Usual Place of Abode. On //20__, at : ☐AM ☐PM, I left the Documents at [SERVICE ADDRESS]—the defendant’s usual place of abode—with [SUBSTITUTE RECIPIENT NAME], a resident of suitable age and discretion, who confirmed residency.

☐ Service on Authorized Agent / Registered Agent. The Documents were delivered to [AGENT NAME], duly authorized to accept service for [ENTITY NAME], at [ADDRESS] on //20__ at : ☐AM ☐PM.

☐ Service via Kentucky Secretary of State. (Non-resident defendant; include Form and mailing receipts as exhibits.)

2. Compliance Statement. I served the Documents in strict conformity with Kentucky Rules of Civil Procedure 4.01 through 4.06, all applicable local rules, and any specific court orders in this Action.

3. Timeliness. Service was effected within the time directed by the Court and, in any event, within the 60-day period prescribed by Ky. R. Civ. P. 4.01(1)(a).

4. Additional Attempts (If Any).
   • Attempt No. 1: //20__, : ☐AM ☐PM — Unsuccessful (Reason: ___)
   • Attempt No. 2: //20__, : ☐AM ☐PM — Unsuccessful (Reason: ___)

[// GUIDANCE: Detailing unsuccessful attempts strengthens any later motion for alternative or constructive service.]

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IV. STATEMENT OF TRUTH

I declare under penalty of perjury under the laws of the Commonwealth of Kentucky that the foregoing is true and correct to the best of my knowledge, information, and belief.

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V. EXECUTION BLOCK

Executed on this ___ day of __, 20.

[AFFIANT SIGNATURE]

Printed Name: ____
Business Address: _____
Telephone: ____
Email (optional): ____

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VI. JURAT / NOTARY ACKNOWLEDGMENT

Commonwealth of Kentucky )
County of ______ )

Subscribed, sworn to, and acknowledged before me by [AFFIANT NAME] on this ___ day of __, 20, to certify which witness my hand and official seal.

Notary Public, State at Large, Kentucky

Commission No.: ___
My Commission Expires: ___

(Seal)

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VII. LIST OF ATTACHMENTS

• Exhibit A – Court Order Appointing Special Bailiff (if applicable)
• Exhibit B – USPS Return Receipt (Certified/Registered Mail)
• Exhibit C – Signed Acknowledgment of Receipt
• Exhibit D – Additional Proof of Service (photographs, GPS logs, etc.)

[// GUIDANCE: Add or remove exhibits as necessary. Kentucky courts expect tangible proof; incomplete submissions risk quashal of service.]