IN THE COUNTY COURT OF POLK COUNTY, FLORIDA

CIVIL DIVISION

CASE NO. _________________

Plaintiff,

vs.

Defendant.

______________________________/ 

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.

                                                                                                                                    __________________________________

                                                                                                                                                   _________________________  

                                                                                                                                                                                         Title

SWORN TO and subscribed before me this _____ day of ________, 19___.

_______________________________________                             ____     Personall Known

NOTARY PUBLIC                                                                       ____     Produced Identification
                                                                                                           Type of identification presented:_____________________
My Commission Expires:

REV. 06/97                                                                                                                            126.doc (06/97)