ATTORNEY OR PARTY WITHOUT ATTORNEY (Name and Address) : TELEPHONE NO.: FOR COURT USE ONLY ATTORNEY FOR (Name) : SUPERIOR COURT OF CALIFORNIA, COUNTY OF LOS ANGELES STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME: PLAINTIFF/PETITIONER: DEFENDANT/RESPONDENT: CASE NUMBER: AFFIDAVIT OF SERVICE OF LOST SUMMONS AND ORDER I, , am and was on (DATE) , a citizen of the United States, over the age of eighteen (18) years and not a party to the above entitled proceeding. On (DATE) , I served a Summons in said proceeding together with on , Defendant/Cross-Defendant/Respondent in said proceeding, in the following manner: q (Personal Service) By personally delivering copies to the person served (CCP 415.10) at the following location: q (Mail and acknowledgement of service) written acknowledgement of receipt). By mailing, first-class or airmail, copies to the person served, together with two copies of the form of notice and acknowledgement and a return envelope, postage prepaid, addressed to the sender (CCP 415.30). Attach q (Certified or registered mail service) By mailing to the address outside California (by registered or certified airmail with return receipt requested) copies to the person served (CCP 415.40. Attach signed return receipt or other evidence of actual delivery to the person served). Mailing date and place of mailing: Address where papers were mailed: q Additional page is attached. 400 RC 180/R7-92 AFFIDAVIT OF SERVICE OF LOST SUMMONS AND ORDER 2000 © American LegalNet, Inc. Said Summons was lost subsequent to its service. This Afidavit is returned in lieu of said Summons. I declare under penalty of perjury that the foregoing is true and correct to the best of my knowledge. Executed at , California, on (DATE) , Name: Address: Telephone: (DECLARANT) GOOD CAUSE appearing, the Court orders this AFFIDAVIT OF SERVICE OF LOST SUMMONS filed in lieu of the original Summons in the above entitled proceeding. Dated: (JUDGE/COMMISSIONER OF THE SUPERIOR COURT) 400 RC 180/R7-92 AFFIDAVIT OF SERVICE OF LOST SUMMONS AND ORDER 2000 © American LegalNet, Inc.