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This form is intended to be used as an attachment to any type of correspondence.  It provides objective third party evidence useful in court to prove that an agent mailed a document to a specified individual on your behalf.  You will very commonly need this type of evidence when interfacing with the IRS, the state taxing authorities, or your employer, because they will frequently claim that they either never received the document or that they lost it, especially if some action or decision is expected that they don't want to deal with.

The Proof of Service by Mail is the strongest form of evidence you can have proving what you sent and when you sent it. It is immediately admissible as evidence because the identity of the party doing the mailing is notarized.  This has the advantage that no personal testimony is required in a court of law in order to establish a foundation for this type of evidence before it is admissible.  The Proof of Service by Mail is also sometimes called the Certificate of Service.  The only disadvantage of a Proof of Service by Mail is that it is more expensive and inconvenient to send because:

  1. It requires three people to send:  1.  You, the sender, 2.  The mail server; 3.  A notary public, all of whom must be at a single place at the same time.  This means that you must be able to find a Postal Annex or Mailboxes Etc, or other mail store that has a notary and another employee on duty simultaneously.
  2. Can be expensive.  Typically, it costs $10 for a notary and another $5 to pay the mail server for their trouble.  Therefore, it can cost as much as $20 to send something with a Proof of Service by Mail.
  3. Is more involved and complicated than the Certified Mail approach, so takes a little more experience to implement.


Republic of __________________)

Subscribed and Affirmed              )

County of ____________________)


I, _________________________, the undersigned mailer/server, being of sound mind and under no duress, do hereby certify, attest and affirm that the following facts are true and correct, to wit:

1.      That, on the _______________, 20___, that, on behalf of (name)_________________, a natural person, the undersigned personally deposited  the following documents (listed below) inside the envelope, sealed them and transmitted them via the carrier indicated in item 2 below, to wit: 


Document Description

of pages


























Total of ____ (  ) documents with combined total of __________ (___) pages.


2.      That I personally mailed said document(s) via (initial those which apply):


       _______United States Postal Office, by regular mail, postage prepaid

       _______United States Postal Office, by Certified Mail # ____ ____ ____ ____ ____, Return Receipt Requested

       _______United Parcel Service (UPS), tracking number  # _____________________

       _______Federal Express, tracking number # ____________________

       _______Other (please specify):_________________________________________________________________


       at said City and State, one (1) complete set of ORIGINAL/COPY (circle one) documents, as described in item 1 above, properly enveloped and addressed to (addressee and address): 








3.   That I am at least 18 years of age;

4.      That I am not related to _______________ by blood, marriage, adoption, or employment, but serve as a “disinterested third party” (herein “Server”); and further,

5.   That I am in no way connected to, or involved in or with, the person and/or matter at issue in this instant action.

I now affix my signature to these affirmations.


(Signature): _______________________________________________________, Mailer/Server

(Printed name): ____________________________________________________





            BEFORE ME, the undersigned authority, a Notary Public, of the County of 


_________, Republic of __________(statename), this _______ day of  ________________________, 20___,


___________________________________mailer/server did appear and was identified by 

driver’s license and who, upon first being duly sworn and/or affirmed, deposes and says that

the aforegoing asseveration is true to the best of his/her knowledge and belief.


            WITNESS my hand and official seal.







                                                Notary Public


My Commission Expires On: