"I hereby certify that I have this day served the foregoing document(s) upon the following parties and limited participants (or designated representatives) in this proceeding at the address indicated by [specify the method]:
(x) [name/address]"
Dated at ______________________________________________this_______day of 19__
(Signature)________________________________________________________________
For______________________________________________________________________
Capacity__________________________________________________________________
S.C. Code Regs. § 9-100.50