IN THE CIRCUIT COURT OF THE STATE OF OREGON
FOR THE COUNTY OF POLK
SMALL CLAIMS DEPARTMENT
______________________________________, ) Affidavit of Mailing
) Case No. _______________
STATE OF OREGON, )
County of Polk )
I, __________________________________, do hereby certify that on the ______ day of
___________________, 20_____, I deposited in the post office at _______________, Oregon, a
sealed envelope which contained a true copy of the Notice of Claim in the above entitled matter,
addressed to the defendant(s) at the address as set forth in the Notice of Claim; the postage on
which was duly prepaid.
A copy of the Notice is attached as required..
Dated at ____________, Oregon, this ______ day of ___________________, 20_____.
Signature of Plaintiff