Section 101.APPENDIX E   Affidavit or Certificate of Service

Section 101.ILLUSTRATION B   Service by Attorney

CERTIFICATE OF SERVICE

I, the undersigned, certify that I have served on the date of ____________ the attached [describe document served] upon the following persons by [describe method of service, e.g., depositing the document in a U.S. Postal Service mailbox or delivering the document to a third-party commercial carrier], by the time of ____________, with proper postage or delivery charges prepaid:

[list persons served and the respective addresses at which they were served]

[signature]

[date]

(Source:  Amended at 39 Ill. Reg. 12848, effective __________)