ATTORNEY OR PARTY WITHOUT (Name, State Bar Number, and address): COURT USE ONLY Telephone No.: ATTORNEY FOR (Name): Fax No. (Optional): Bar No.: SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN BERNARDINO STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME APPEAL OF (NAME): RESPONDENTS: PROOF OF SERVICE NOTICE OF APPEAL (CODE ENFORCEMENT) CASE NUMBER: 1. At the time of service, I was at least 18 years old and not a party to this action. I served this Notice of Appeal (Code Enforcement) on the agency named below in the manner indicated below: 2. My residence or business address is as follows: _____________________________________________________________________________ 3. Manner of Service (check and complete (a) or (b) below): (a) Personal Service. I personally delivered a true copy of the Notice of Appeal as follows: Name of Person document left with: Date of Service Time of Service: Address where delivered: (b) First Class Mail. I am employed in, or a resident of, the county where the notice was mailed. I deposited a true copy of the Notice of Appeal in the United States mail, enclosed in a sealed envelope with prepaid First Class postage as follows: Date of Mailing: Place of Mailing (City and State) Envelope addressed as follows: Name: Address: I declare under penalty of perjury, under the laws of the State of California, that the foregoing is true and correct. _________________________________ Date _________________________________ Printed Name: ____________________________________ Signature PROOF OF SERVICE NOTICE OF APPEAL (CODE ENFORCEMENT) 13-19890-360, Rev 04-2014 American LegalNet, Inc. www.FormsWorkFlow.com