(A) To a person empowered by law to serve legal process, or the attorney for a party in whose behalf service will be made, or a party who is acting
pro se,
1 upon receipt of written information that specifically includes all of the following:
1The term pro se means that a party is not represented by an attorney but by himself or herself.
(1) A certification that the name or address is needed and will be used solely for service of legal process in connection with actual or prospective litigation;
(2) A citation to the statute or regulation that empowers the requester to serve process, if the requester is other than the attorney for a party in whose behalf service will be made, or a party who is acting
pro se;
(3) The names of all known parties to the litigation;
(4) The court in which the case has been or will be commenced;
(5) The docket or other identifying number, if one has been issued; and
(6) The capacity in which the boxholder is to be served,
e.g., defendant or witness.