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DR 58 - Revised 13 February 2001
Circuit Court for Case No.
City or County
Name Name
VS.
Street Address Apt. # Street Address Apt. #
( ) ( )
City State Zip Code Area Telephone City State Zip Code Area Telephone
Code Code
Plaintiff Defendant
CERTIFICATE OF SERVICE
(DOM REL 58)
I HEREBY CERTIFY that on this day of , , a copy
of the document(s) entitled
Title of Document(s)
was/were mailed, postage prepaid to:
Opposing Party or His/Her Attorney
Address
City State Zip
Date Signature