Process Service Documentation Form

Date:___________

STAFF DELIVERING DOCUMENTS

Last Name:
Employee #:

PROCESS SERVER INFORMATION
(leave blank if unknown)

First Name:
Last Name:

Appointment date:
Time: _____A.M. ______P.M.

Organization/Company:

OFFENDER INFORMATION

First Name:
Last Name:

IDOC #:
Facility:
Unit:
Bunk:

Date:
Time: _____A.M. ______P.M.

CONFIRMATION OF DELIVERY

Process server to wait for confirmation?  Yes  No

It is the process server’s responsibility to complete the affidavit of service and send it to the court. Service of process can be completed upon leaving the documents at the place
of residence which should be in the affidavit of service so the process server may or may not wait for confirmation of delivery.

Please give this completed form to the person designated in the facility field memorandum.