ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): TELEPHONE NO.: E-MAIL ADDRESS (Optional): ATTORNEY FOR (Name): FOR COURT USE ONLY FAX NO. (Optional): SUPERIOR COURT OF CALIFORNIA, COUNTY OF IMPERIAL 939 Main Street El Centro, CA 92243 PETITIONER: RESPONDENT: Attachment 3d to Proof of Service of Summons FL-115 Declaration of Service by Mailing and Posting in Lieu of Publication (CCP § 413.30) CASE NUMBER: 1. I, the undersigned, declare as follows: I am over the age of 18 years and not a party to this case. 2. Pursuant to a court order dated ___________________, a. On __________, I mailed a copy of the Summons and Petition, in an envelope addressed to Respondent, postage prepaid, to Respondent at his/her last known address of: Address City State Zip b. On __________, I posted a copy of the Summons and Petition on ___________________ in one public place, namely, the public bulletin board at the front door of the Superior Court, 939 Main Street, El Centro CA. I declare under penalty of perjury, under the laws of the State of California, that the foregoing is true and correct, and that this declaration was signed at _____________, California. Date: _________________ Signature: ________________________________ Print Name: _______________________________ Form Approved for Optional Use FL-10 For use with FL-09 (Adopted 01/1/11) American LegalNet, Inc. www.FormsWorkFlow.com