POS-010 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): FOR COURT USE ONLY TELEPHONE NO.: E­MAIL ADDRESS (Optional): ATTORNEY FOR (Name): FAX NO. (Optional): SUPERIOR COURT OF CALIFORNIA, COUNTY OF STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME: PLAINTIFF/PETITIONER: DEFENDANT/RESPONDENT: CASE NUMBER: Ref. No. or File No.: PROOF OF SERVICE OF SUMMONS (Separate proof of service is required for each party served.) 1. 2. At the time of service I was at least 18 years of age and not a party to this action. I served copies of: a. b. c. d. e. f. 3. summons complaint Alternative Dispute Resolution (ADR) package Civil Case Cover Sheet (served in complex cases only) cross-complaint other (specify documents): a. Party served (specify name of party as shown on documents served): b. Person (other than the party in item 3a) served on behalf of an entity or as an authorized agent (and not a person under item 5b on whom substituted service was made) (specify name and relationship to the party named in item 3a): 4. 5. Address where the party was served: I served the party (check proper box) by personal service. I personally delivered the documents listed in item 2 to the party or person authorized to receive service of process for the party (1) on (date): (2) at (time): by substituted service. On (date): at (time): I left the documents listed in item 2 with or in the presence of (name and title or relationship to person indicated in item 3): (1) (2) (3) (business) a person at least 18 years of age apparently in charge at the office or usual place of business of the person to be served. I informed him or her of the general nature of the papers. (home) a competent member of the household (at least 18 years of age) at the dwelling house or usual place of abode of the party. I informed him or her of the general nature of the papers. (physical address unknown) a person at least 18 years of age apparently in charge at the usual mailing address of the person to be served, other than a United States Postal Service post office box. I informed him or her of the general nature of the papers. I thereafter mailed (by first-class, postage prepaid) copies of the documents to the person to be served at the place where the copies were left (Code Civ. Proc., § 415.20). I mailed the documents on (date): from (city): or a declaration of mailing is attached. I attach a declaration of diligence stating actions taken first to attempt personal service. Page 1 of 2 a. b. (4) (5) Form Adopted for Mandatory Use Judicial Council of California POS-010 [Rev. January 1, 2007] PROOF OF SERVICE OF SUMMONS Code of Civil Procedure, § 417.10 American LegalNet, Inc. www.FormsWorkflow.com PLAINTIFF/PETITIONER: DEFENDANT/RESPONDENT: CASE NUMBER: 5. c. by mail and acknowledgment of receipt of service. I mailed the documents listed in item 2 to the party, to the address shown in item 4, by first-class mail, postage prepaid, (1) on (date): (3) (4) (2) from (city): with two copies of the Notice and Acknowledgment of Receipt and a postage-paid return envelope addressed to me. (Attach completed Notice and Acknowledgement of Receipt.) (Code Civ. Proc., § 415.30.) to an address outside California with return receipt requested. (Code Civ. Proc., § 415.40.) d. by other means (specify means of service and authorizing code section): Additional page describing service is attached. 6. The "Notice to the Person Served" (on the summons) was completed as follows: as an individual defendant. a. b. as the person sued under the fictitious name of (specify): c. as occupant. d. On behalf of (specify): under the following Code of Civil Procedure section: 416.10 (corporation) 416.20 (defunct corporation) 416.30 (joint stock company/association) 416.40 (association or partnership) 416.50 (public entity) 7. Person who served papers a. Name: b. Address: c. Telephone number: d. The fee for service was: $ e. I am: (1) (2) (3) not a registered California process server. exempt from registration under Business and Professions Code section 22350(b). a registered California process server: (i) owner employee independent contractor. (ii) Registration No.: (iii) County: 415.95 (business organization, form unknown) 416.60 (minor) 416.70 (ward or conservatee) 416.90 (authorized person) 415.46 (occupant) other: 8. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. or 9. Date: I am a California sheriff or marshal and I certify that the foregoing is true and correct. (NAME OF PERSON WHO SERVED PAPERS/SHERIFF OR MARSHAL) (SIGNATURE ) POS-010 [Rev. January 1, 2007] PROOF OF SERVICE OF SUMMONS Page 2 of 2