ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): FOR COURT USE ONLY TELEPHONE NO.: EMAIL ADDRESS: ATTORNEY FOR (Name): STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME: FAX NO.: SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN BERNARDINO IN THE MATTER OF THE PETITION OF: CITATION - ADOPTION THE PEOPLE OF THE STATE OF CALIFORNIA, CASE NUMBER: 1. TO (name): _______________________________________________________________________________________ 2. You are hereby cited and required to appear at a hearing in this court on a. Date: b. Address of court: Time: Department: same as noted above other (specify): 3. At this hearing you are required to give any legal reason why the relief requested in the verified petition attached to and served with this citation, and filed with this court, should not be granted. Date: ___________________ NOTICE TO THE PERSON SERVED: You are served Clerk, by ______________________________, Deputy c. as an individual b. as the person cited under a. the fictitious name of (specify): On behalf of (specify): under (Seal) Code Civ. Proc., § 416.10 (corporation) Code Civ. Proc., § 416.20 (defunct corporation) Code Civ. Proc., § 416.40 (association or partnership) Code Civ. Proc., § 416.60 (minor) Code Civ. Proc., § 416.90 (individual) other (specify): d. by person delivery on (date): 13-21906-360 Revised 7/13/2016 CITATION ­ ADOPTION Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com IN THE MATTER OF THE PETITION OF: CASE NUMBER: PROOF OF SERVICE 1. 2. At the time of service I was at least 18 years of age and not a party to this proceeding. I served copies of the Citation for: a. Person cited (name):________________________________________________ b. Person served: (1) person in item 2a (2) other (specify name and title or relationship to the person named in item 2a): _____________________ ___________________________________________________________________________________________ c. Address (specify): __________________________________________________________________________________________ 3. I served the person named in item 2 a. by personally delivering the copies (1) on (date): ________________________ (2) at (time):______________________ b. by mailing the copies to the person served, addressed as shown in item 2c, by first-class mail, postage prepaid, (1) on (date):____________________________ (2) from (city): ______________________________________ c. with two copies of the Notice and acknowledgement of Receipt-Civil and a postage-paid return envelope addressed to me. (Attach completed Notice and Acknowledgement of Receipt-Civil (form POS-015).) d. to an address outside California with return receipt requested. (Attach completed return receipt.) e. other (specify other manner of service, and the authorizing code section and order of the court):____________________ __________________________________________________________________________________________________ 4. a. Person serving (name, address, and telephone number):___________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ Fee for service: $_____________ Not a registered California process server. Exempt from registration under Business and Professions Code section 22350(b) Registered California process server. Employee or independent contractor. Registration No. (specify): ___________________________________________________________________________ (1) County (specify): ______________________________________ (2) Expiration (date):______________________ b. c. d. e. f. g. 5. 6. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. I am a California Sheriff and I certify that the foregoing is true and correct. Date: ________________________________________ (SIGNATURE OF PERSON SERVING) 13-21906-360 Revised 7/13/2016 CITATION ­ ADOPTION Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com