FORM 16C

CERTIFICATE OF SERVICE BY SHERIFF

(General Heading — Form 4A or 4B)

CERTIFICATE OF SERVICE BY SHERIFF

I, (full name), sheriff (or sheriff's officer) of the Judicial Centre, certify that on (date), at (time), I served identify person served) with (identify documents served) by leaving a copy with him (or her) at (address where service was made). (Where the rules provide for personal service on a corporation, etc. by leaving a copy of the document with another person, substitute: by leaving a copy with (identify person by name and title) at (address where service was made).

I was able to identify the person by means of (state the means by which the person's identity was ascertained).

(Date)

(signature of sheriff or sheriff's officer)