For Official Use Amended Affidavit of Service WILLIAM ELLIOTT, (Probate) SAMPLE deceased Case No. 11PR111 I, Mary of Someplace , (Name) (City) August 1, 2011 State of Wisconsin , being sworn, state that on , I (Date) provided copies of the following documents: Documents Provided Notice to Creditors the original of which is on file, OR a copy of which is attached (no original on file) to the following named persons at the mailing address as listed: See attached NAME MAILING ADDRESS TYPE OF SERVICE*** Northwest Savings Bank 1 Northwest Plaza, Someplace, WI 51111 First class mail Southeast Savings & Loan 101 Fifth Street, Someplace, WI 51111 First class mail Type of Service: *** TYPE OF SERVICE: to Wisconsin Statutes for proper manner of service. Personal Service Mail Certified mail return receipt requested ► of Signature Mary Smith County of Print or Type Name Subscribed and sworn to before me on 555 Street Address Notary Official Someplace, WI 51111 Name Printed or Typed (715) 999-9999 My commission/term expires: Telephone Number Form completed by: (Name) August 2, 2011 Mary Smith Date Address 555 Blank Street Someplace, WI 51111 Telephone Number Bar Number (If any) (715) 999-9999 N/A PR-1817, 10/10 Affidavit of Service (Probate) §§865.11(2), 865.16(1)(c), 879.05 and 879.07, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material.
For Official Use SAMPLE WILLIAM ELLIOTT, Amended Affidavit of Service (Probate) deceased Case No. 11PR111 I, (Name) Mary of (City) Someplace , State of Wisconsin , being sworn, state that on (Date) August 1, 2011 , I provided copies of the following documents: Documents Provided Notice to Creditors the original of which is on file, OR a copy of which is attached (no original on file) to the following named persons at the mailing address as listed: See attached NAME MAILING ADDRESS TYPE OF SERVICE*** Northwest Savings Bank Southeast Savings & Loan 1 Northwest Plaza, Someplace, WI 51111 101 Fifth Street, Someplace, WI 51111 First class mail First class mail *** TYPE OF SERVICE: to Wisconsin Statutes for proper manner of service. Type of Service: Personal Service Mail Certified mail return receipt requested ► of County of Subscribed and sworn to before me on Notary Official Name Printed or Typed My commission/term expires: Signature Mary Smith Print or Type Name 555 Street Address Someplace, WI 51111 (715) 999-9999 Telephone Number August 2, 2011 Date Form completed by: (Name) Mary Smith Address 555 Blank Street Someplace, WI 51111 Telephone Number (715) 999-9999 Bar Number (If any) N/A PR-1817, 10/10 Affidavit of Service (Probate) §§865.11(2), 865.16(1)(c), 879.05 and 879.07, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material.