604.26—Complaints and decisions regarding removal of private charter operators or qualified human service organizations from registration list.

I hereby certify that I have this day served the foregoing [name of document] on the following persons at the following addresses and e-mail or facsimile numbers (if also served by e-mail or facsimile) by [specify method of service]:
[list persons, addresses, and e-mail or facsimile numbers]
Dated this ____ day of ____, 20__.
[signature], for [party].