Bear River Band Tribal Court
PROOF OF SERVICE
Court File Number:
Case Type:
(For Court Personnel Only)
Bear River Band Tribal Court
266 Keisner Road
Loleta, CA 95551
(707
) 773-1900 phone
(707) 773-1719 fax
Full Name of Person Being Served:
Document(s) Being Served:
Location of Service:
(mailing address or physical location of service)
3.
2.
1.
(first, middle, and last )
State:
Zip:
Time:
Declaration and Information of Server:
AT THE TIME OF SERVICE, I was at least 18 (eighteen) years of age and NOT a party to the
above entitled action. (Check One):
I DECLARE under penalty of perjury of the laws of the Bear River Band of the Rohnerville Rancheria
that the information provided on this Proof of Service is true and correct to the best of my knowledge.
OR
Date and Time of Service:
(Date: month/day/year)
(Time: approximate if exact is not known)
4.
5.
Signature
I AM A SWORN law enforcement officer, sheriff, marshal, or constable and I certify that the information
provided on this Proof of Service is true and correct to the best of my knowledge.
List Jurisdiction/Authorizing Entity:
Date:
Printe
d Name of Server
Mailing Address:
Email:
Contact Phone Number:
Mail
Personal
click to sign
signature
click to edit
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