4. INFORMATION FOR SERVICE 
   
   

   1. YOU MUST HAVE A PHYSICAL ADDRESS FOR SERVICE THAT IS IN THE CITY AND COUNTY OF BROOMFIELD. 

   2. ALL FEES WILL BE PAID IN ADVANCE. IN ACCORDANCE WITH 30-1-116 C.R.S. Fees quoted are per person/service, NOT per location or attempt. If service is not effected, a portion of the service fee will be refunded to you. Process may be returned after three unsuccessful service attempts. 

   3. Complete the following information.

6. NAME OF PARTIES TO BE SERVED: *
8. DOB: *
9. AGE:*
10. SEX: *
11. RACE:*
13. HEIGHT:*
14. WEIGHT: *
15. EYES: *
16. HAIR:*
18. HOME ADDRESS:*
20. EMPLOYER NAME & ADDRESS: *
22. CELL PHONE: *
23. WORK PHONE:
25. VEHICLE MAKE: *
26. MODEL AND YEAR: *
27. COLOR:*
28. LICENSE PLATE #:*
30. Distinguishing Marks/Other Information:

32. (i.e. beard, mustache, missing teeth, balding, cleft chin, earrings, glasses, bushy eyebrows, scars, marks, tattoos, body piercings, or any other distinguishing marks)

36. Will the DEFENDANT be abusive toward the officer?*

    Only check one

    1. YES
    2. NO
    3. UNKNOWN
37. Is the DEFENDANT aware you have a paper to serve?*

    Only check one

    1. YES
    2. NO
    3. UNKNOWN
39. Does the DEFENDANT have any weapons?*

    Only check one

    1. YES
    2. NO
    3. UNKNOWN
40. If the DEFENDANT has weapons, what type are they?
42. Does the DEFENDANT have any arrest warrants? *

    Only check one

    1. YES
    2. NO
    3. UNKNOWN
44. *If this is a temporary or permanent restraining order, do you wish to be NOTIFIED by phone once the order has been served? *

    1. YES
    2. NO
45. If you would like to be notified, what phone number is best to contact you?
49. YOUR NAME:*
51. HOME ADDRESS: *
53. CITY: *
54. STATE: *
55. ZIP: *
57. CELL PHONE: *
58. WORK PHONE:

60. I understand that the officer will attempt to effect service based on the information provided. All process served by the Broomfield Police Department is done in accordance with the applicable Colorado Court Rules. 

62. Signature:

    Must sign in-person. Electronic signature will not be accepted. 

63. Date:
Leave This Blank:


64. Print Only

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