NAME, ADDRESS, AND TELEPHONE NUMBER OF PARTY: RESERVED FOR CLERK’S FILE STAMP SUPERIOR COURT OF CALIFORNIA, COUNTY OF LOS ANGELES COURTHOUSE ADDRESS: PLAINTIFF: DEFENDANT: CASE NUMBER: REQUEST FOR CERTIFIED MAIL (SMALL CLAIMS) I am the Plaintiff Defendant in the above entitled action and hereby request that my claim be served via certified mail addressed as follows: Party Name: ________________________________________________ Agent for Service (if applicable): ________________________________________________ Party or Agent for Service Address: ________________________________________________ City, State and Zip Code: ________________________________________________ NOTE: The clerk will attempt to serve your claim by certified mail, return receipt requested, restricted delivery (to be signed by addressee only) for a separate fee for each party served. THIS SERVICE IS NOT GUARANTEED TO BE RELIABLE. THERE IS NO REFUND IF THE PARTY IS NOT SERVED. THE COURT WILL NOT NOTIFY YOU AS TO WHETHER OR NOT THE CLAIM HAS BEEN SERVED. You may call the Small Claims Office, or visit the court’s website at www.lasuperiorcourt.org, to learn if the party has been served. Date: ________________________ Name: ___________________________________ _________________________________________ Signature SCLA 010 (New) LASC Approved 08-08 REQUEST FOR CERTIFIED MAIL (SMALL CLAIMS) Code Civ. Proc., § 116.340(a)(1) American LegalNet, Inc. www.FormsWorkFlow.com