State of California County of Los Angeles (File Stamp) Term of Registration: 2 years CERTIFICATE OF REGISTRATION AS A PROCESS SERVER California Business & Professions Code Sections 22350, 22351(a), et seq. The undersigned individual declares that: Name:___________________________________________________________________________________ Address:_________________________________________________________________________________ Age:___________________________ Telephone Number:______________________________ The filing of this registration in the County of Los Angeles is appropriate because my ( ) residence or ( ) principal place of business is located in this County. Have you been a resident of California for at least one year immediately preceding the filing of this certificate? ( ) YES Have you ever been convicted of a felony? If yes, attach a copy of a certificate of rehabilitation, expungement or pardon. ( ) YES ( ) NO ( ) NO Will you perform the duties of a process server in compliance with the provision of law governing the ( ) YES service of process in the State of California? ( ) NO The undersigned declares under the penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date: ___________________ Signature: _______________________________________________________ For Official Use Only: Permanent ID card mailed: Expiration Date: Registration#: Rev. 1/2010 American LegalNet, Inc. www.FormsWorkFlow.com