| Name | PLAINTIFF |
|---|---|
| vs. | |
| Name | DEFENDANT 1 |
| and (if applicable) | |
| Name | DEFENDANT 2 |
CASE NO. _____
ACTION IN CUSTODY
The undersigned hereby certifies that on this date, a true and correct copy of the foregoing PRE-TRIAL CONFERENCE MEMORANDUM, PARENTING PLAN, and CRIMINAL RECORD/ABUSE HISTORY VERIFICATION was served by first class mail to the following:
Name of person served
Street Address of person served
City State Zip Code
Date: ___ Signature of person certifying service
Date: ___
Signature of person certifying service
Name of person certifying service (printed or typed)
Street Address of person certifying service
___
City State Zip Code
Area Code Telephone Number of person certifying service Certificate of Service – Pre-Trial Conference/Parenting Plan/History Verification – Form #1 Page 1 of 1