CBF No. 14.

19
Proof of Service by
Pubilcation

Original – Court, 1st Copy – Plaintiff, 2nd Copy – Defendant, Other copies as needed
Enter information in block letters in all parts of the Form except when reserved for Court
use, which shall be completed by the Clerk.
For Court Use Only
(Judicial Region)

(Municipality/City/Province)

METC/MTCC/MTC/MCTC
RTC

BRANCH
Case No.
Plaintiff/
Petitioner , v.
Defendant/
Respondent

COUNSEL OR PARTY WITHOUT COUNSEL

Nam
e
Firm Name
Address
Email Address
Tel./Cel./Fax Nos.
PTR No. Date/
Roll No. Place of Issue
Lifetime
IBP No. Date/Chapter
Compliance
MCL Exemption No
E .
Other Compliances
Counsel for
Plaintiff/
Petitioner
Defendant/
Respondent
Other

PROOF OF SERVICE BY PUBLICATION

UNDER RULE 14.19

states:
(name)
1. In its Order, the Court allowed the
(date)
service of summons by publication.

2. As proof of service by publication in

(name of publication)
attached are:
 a. Affidavit of the printer, his foreman or principal clerk or
of the editor, business or advertising manager
b. Copies of the publication; and
c. Affidavit that copy of the summons and order for publication
have been deposited with the post office, postage prepaid,
directed to the defendant by registered mail to his/her last
known address.

Date Party/Party’s Counsel Name and Signature

ORDER
The submission is
 noted. The plaintiff is deemed to have complied with the Proof of Service by
Publication.
 deemed insufficient. The plaintiff is directed to
 a. present the following proof:

Affidavit of the printer, his foreman or principal clerk or of the editor,

business or advertising manager
Copies of the publication; and
Affidavit that copy of the summons and order for publication have been
deposited with the post office, postage prepaid, directed to the defendant by
registered mail to his/her last known address.

 b. cause publication anew in accordance with the Order dated _______

because __________________________________________________________.

Judge Date

SPECIAL INSTRUCTIONS

PROOF OF SERVICE BY PUBLICATION page 2 of 2