CASE NUMBER:
PLAINTIFF:
DEFENDANT:
PROOF OF SERVICE
(After having the other party served as described below, with any of the documents identified in item 1, have the person who served
the documents complete this Proof of Service. Plaintiff cannot serve these papers.)
1. I served the
Other (specify):a. Statement of Damages
b. on (name):
defendant other (name and title or relationship to person served):c. by serving
at home at businessd. by delivery
(1) date:
(2) time:
(3) address:
e. by mailing
(1) date:
(2) place:
2. Manner of service (check proper box):
a. Personal service. By personally delivering copies. (CCP § 415.10)
Substituted service on corporation, unincorporated association (including partnership), or public entity. By
leaving, during usual office hours, copies in the office of the person served with the person who apparently was in
charge and thereafter mailing (by first-class mail, postage prepaid) copies to the person served at the place where the
b.
copies were left. (CCP § 415.20(a))
Substituted service on natural person, minor, conservatee, or candidate. By leaving copies at the dwelling house,
usual place of abode, or usual place of business of the person served in the presence of a competent member of the
household or a person apparently in charge of the office or place of business, at least 18 years of age, who was
informed of the general nature of the papers, and thereafter mailing (by first-class mail, postage prepaid) copies to the
person served at the place where the copies were left. (CCP § 415.20(b)) (Attach separate declaration or affidavit
stating acts relied on to establish reasonable diligence in first attempting personal service.)
c.
Mail and acknowledgment service. By mailing (by first- class mail or airmail, postage prepaid) copies to the person
served, together with two copies of the form of notice and acknowledgment and a return envelope, postage prepaid,
addressed to the sender. (CCP § 415.30) (Attach completed acknowledgment of receipt.)
d.
Certified or registered mail service. By mailing to an address outside California (by first-class mail, postage prepaid,
requiring a return receipt) copies to the person served. (CCP § 415.40) (Attach signed return receipt or other
evidence of actual delivery to the person served.)
e.
Other (specify code section):
f.
additional page is attached.
3. At the time of service I was at least 18 years of age and not a party to this action.
f. Name, address and telephone number and, if applicable,
county of registration and number:
a. California sheriff, marshal, or constable
b. Registered California process server
Employee or independent contractor of a registered
c.
California process server
d. Not a registered California process server
Exempt from registration under Bus. & Prof. Code
§ 22350(b)
e.
(For California sheriff, marshal, or constable use only)
I certify that the foregoing is true and correct.
I declare under penalty of perjury under the laws of the
State of California that the foregoing is true and correct.
Date: Date:
(SIGNATURE) (SIGNATURE)
CIV-050 [Rev. January 1, 2007]
Page 2 of 2
PROOF OF SERVICE
(Statement of Damages)
Code of Civil Procedure §§ 425.11, 425.115
5. Person serving:
4. Fee for service: $
CIV-050
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