Instructions: To certify that you sent copies to the other parties, attach this form to all documents filed with the Board that were not served on other parties via email. Use additional pages if necessary




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INSTRUCTIONS: To certify that you sent copies to the other parties, attach this form to all documents filed with the Board that were not served on other parties via email. Use additional pages if necessary. You do not need to provide a copy of this form to the party being served.

CS-1740

REV 4/2015


State of Michigan

Civil Service Commission


EMPLOYMENT RELATIONS BOARD


400 South Pine Street, Suite 102, Lansing, Michigan 48913

or P.O. Box 30002, Lansing, Michigan 48909

Telephone: 517-335-5588

E-MAIL: MCSC-ERB@michigan.gov

WEBSITE: www.mi.gov/erb

Proof of Service to Other Parties


Case Name

     


Decision Number

     


Reference Number

     




Parties Served
Delivery Method Used

Name and Address

     


 Personal Delivery

 First Class U.S. Postal Service

 Overnight Mail Service

 Interdepartmental Mail

 Certified U.S. Postal Service: Receipt No.      

 Other:      

Name and Address

     


 Personal Delivery

 First Class U.S. Postal Service

 Overnight Mail Service

 Interdepartmental Mail

 Certified U.S. Postal Service: Receipt No.      

 Other:      

Name and Address

     


 Personal Delivery

 First Class U.S. Postal Service

 Overnight Mail Service

 Interdepartmental Mail

 Certified U.S. Postal Service: Receipt No.      

 Other:      
Documents Served

I,       , certify that on       , I served all parties or their representative(s) of record, at the address(es) shown above, with a copy of the following documents:

  1.      

  1.      

  1.      

  1.      




Signature and Mailing Address of Filing Party

Signature

     


Date

     


Name (Please Print)

     


Street Address

     


City

     


State

     


Zip

     



EMAIL

     





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