IN THE CIRCUIT COURT OF THE TWENTIETH JUDICIAL 
CIRCUIT IN AND FOR CHARLOTTE COUNTY, FLORIDA

IN RE:
THE ESTATE/GUARDIANSHIP OF: 		Case No.:_____________
							Division: _____________

_____________________________________,
                                                   Decedent/Ward/
	
DESIGNATION OF PRIMARY ADDRESS FOR SERVICE OF PAPERS

Instructions:  A party not represented by an attorney may choose to designate E-mail address(es) for service. A primary and up to two secondary E-mail addresses can be designated. If you do so and the other party is represented by an attorney or has also designated E-mail address(es) for service, E-mail will be the exclusive means of service.
 
(Choose One - #1 or #2)

1.  E-Mail Designation:

     I, (full legal name)___________________________________________, being sworn, certify

that my current E-mail address is _________________________@_______________________.
   □  I hereby designate my E-mail address for receipt of all future papers in this lawsuit.  I understand that in the future I may change my address if I wish to be served at a physical location by filing an amended designation of primary address for service of papers form.

OR

2.  Physical Mail Designation:

    □   I, (full legal name)___________________________________________, being sworn, certify that my current physical mailing address is (Street)_______________________________

_________________________, (City)____________________________, (State)____________, 

(Zip)_________________(Telephone Number)_________________ (Fax )_________________
I understand that I must keep the clerk's office and the opposing party or parties notified of my current address and that all future papers in this lawsuit will be served at the address(es) on record at the clerk's office.
			_____________________________		____________
			My Signature					Date
DESIGNATION OF PRIMARY ADDRESS FOR SERVICE OF PAPERS
PAGE 2

STATE:________________________

COUNTY:______________________
Sworn to or affirmed and signed before me on (Date)__________by_______________________

________________________________.

___________________________________
NOTARY PUBLIC OR DEPUTY CLERK

___________________________________
(Print, type, or stamp commissioned name of
notary or clerk.)
_____________Personally known
_____________Produced Identification.  Type produced:________________________________

Certificate of Service

I certify that a copy of this document was ______E-Mailed ______ Mailed _______ Faxed
______Hand Delivered to the person(s) listed below on (date)___________________.

Other party or his/her attorney:
Name:________________________ Address:___________________________________

City, State, Zip: ______________________ Fax Number: _________________________

Designated E-mail Address(es): _________________________________________

Other party or his/her attorney:
	Name:________________________ Address:___________________________________

City, State, Zip: ______________________ Fax Number: _________________________

Designated E-mail Address(es): ______________________________________________

_________________________	_____________
My Signature				Date