IN THE COURT OF COMMON PLEAS OF LEHIGH COUNTY, PENNSYLVANIA

CIVIL ACTION

)	NO.
Plaintiff	)
vs	)	CUSTODY
)
Defendant	)

CUSTODY COMPLAINT AND RELATED DOCUMENTS –

AFFIDAVIT OF SERVICE BY COMMERCIAL CARRIER

Pursuant to Pa. R.C.P. 1930.4

On	(date documents mailed and submitted to commercial carrier for service),
I,	, Plaintiff in the within action, mailed to the Defendant
copies of the filed Complaint for Custody, scheduling Order of Court, Plaintiff’s completed Criminal Record/Abuse History Verification and a blank Criminal Record/Abuse Verification form for Defendant to complete and file, by United States Postal Service (USPS) first-class regular mail to the Defendant’s last
known address at	(fill in address).
I also submitted the aforesaid documents to a commercial carrier,	(name of carrier)
to restrict delivery by the commercial carrier to the Defendant’s address only, with a request that the carrier provide a return receipt (hard copy or electronic) detailing the date and time of delivery, the delivery address, and the name of the person (if available) to whom the documents were delivered.

Complete A, B, or C:

A.	On	(date of Defendant’s signature on return receipt), Defendant
received the aforesaid documents. The return receipt bearing the Defendant’s purported signature and the information requested above indicating receipt of the aforesaid documents from the commercial carrier is attached hereto and made a part of this Affidavit.

OR

B.	On	(date of delivery as indicated on return receipt), the aforesaid
documents were delivered by commercial carrier to the Defendant’s address consistent with the commercial carrier’s policy and the first-class regular mail was not returned within fifteen (15) days of mailing. The return receipt from the carrier bearing the available information requested above is attached hereto1 and made a part of this Affidavit.

OR

C.	On	(date of refusal by Defendant to accept delivery as referenced
on the aforesaid documents or a return receipt), the Defendant refused to accept delivery of the aforesaid documents, but the first-class regular mail was not returned within fifteen (15) days of mailing. The return receipt or the aforesaid documents from the carrier bearing the available information requested above is attached hereto1 and made a part of this Affidavit.

I verify that the statements in this document are true and correct to the best of my knowledge, information, and belief. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. § 4904, relating to unsworn falsification to authorities.

Date:
Plaintiff’s Signature:

This Affidavit is incomplete unless you attach the commercial carrier’s return receipt or the aforesaid documents, if applicable.

Rachel A Wotring

2023-02-01