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PETITION FOR ALTERNATIVE WRIT OF MANDATE TO SET (The Superior Court of California - County of Orange)

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PETITION FOR ALTERNATIVE WRIT
OF MANDATE TO SET ASIDE
SUSPENSION OF DRIVING
PRIVILEGE – DUI
BOOKLET
SUPERIOR COURT OF CALIFORNIA
COUNTY OF ORANGE
L- 1158 (New March 2, 2009)
American LegalNet, Inc.
www.FormsWorkflow.com
CM-010
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address):
FOR COURT USE ONLY
TELEPHONE NO.: FAX NO.:
ATTORNEY FOR (Name):
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
CASE NAME:
CIVIL CASE COVER SHEET
Complex Case Designation
LimitedUnlimited
Counter Joinder
(Amount(Amount
demanded isdemanded Filed with first appearance by defendant
(Cal. Rules of Court, rule 3.402)
$25,000 or less)exceeds $25,000)
Items 1–6 below must be completed (see instructions on page 2).
1. Check one box below for the case type that best describes this case:
Auto Tort
Contract
Provisionally Complex Civil Litigation
(Cal. Rules of Court, rules 3.400–3.403)
Auto (22)
Breach of contract/warranty (06)
Uninsured motorist (46)
Other collections (09)
Antitrust/Trade regulation (03)
Other PI/PD/WD (Personal Injury/Property
Damage/Wrongful Death) Tort
Construction defect (10)
Insurance coverage (18)
Mass tort (40)
Rule 3.740 collections (09)
Asbestos (04)
Securities litigation (28)
Real Property
Product liability (24)
Environmental/Toxic tort (30)
Eminent domain/Inverse
condemnation (14)
Medical malpractice (45)
Insurance coverage claims arising from the
above listed provisionally complex case
types (41)
Other PI/PD/WD (23)
Wrongful eviction (33)
Non-PI/PD/WD (Other) Tort
Enforcement of Judgment
Business tort/unfair business practice (07)
Enforcement of judgment (20)
Civil rights (08)
Commercial (31)
Miscellaneous Civil Complaint
Defamation (13)
Residential (32)
RICO (27)
Fraud (16)
Drugs (38)
Other complaint (not specified above) (42)
Intellectual property (19)
Judicial Review
Miscellaneous Civil Petition
Asset forfeiture (05)
Partnership and corporate governance (21)
Petition re: arbitration award (11)
Employment
Writ of mandate (02)
Wrongful termination (36)
Other judicial review (39)
is2. This case is not complex under rule 3.400 of the California Rules of Court. If the case is complex, mark the
factors requiring exceptional judicial management:
Extensive motion practice raising difficult or novel
issues that will be time-consuming to resolve
Large number of witnesses a.
b.
f.
c.
3. Remedies sought (check all that apply):
punitive
a.
monetary
nonmonetary; declaratory or injunctive relief
c.
4. Number of causes of action (specify):
is
is not a class action suit.
5. This case
Date:
(TYPE OR PRINT NAME)
(SIGNATURE OF PARTY OR ATTORNEY FOR PARTY)
NOTICE
Plaintiff must file this cover sheet with the first paper filed in the action or proceeding (except small claims cases or cases filed
under the Probate Code, Family Code, or Welfare and Institutions Code). (Cal. Rules of Court, rule 3.220.) Failure to file may result
in sanctions.
File this cover sheet in addition to any cover sheet required by local court rule.
If this case is complex under rule 3.400 et seq. of the California Rules of Court, you must serve a copy of this cover sheet on all
other parties to the action or proceeding.
Unless this is a collections case under rule 3.740 or a complex case, this cover sheet will be used for statistical purposes only.
Page 1 of 2
Cal. Rules of Court, rules 2.30, 3.220, 3.400–3.403, 3.740;
Cal. Standards of Judicial Administration, std. 3.10
www.courtinfo.ca.gov
Form Adopted for Mandatory Use
Judicial Council of California
CM-010 [Rev. July 1, 2007]
CIVIL CASE COVER SHEET
Other non-PI/PD/WD tort (35)
Professional negligence (25)
Other real property (26)
Other petition (not specified above) (43)
Other employment (15)
e.
d.
Substantial amount of documentary evidence
Large number of separately represented parties
Coordination with related actions pending in one or more courts
in other counties, states, or countries, or in a federal court
Substantial postjudgment judicial supervision
Unlawful Detainer
CASE NUMBER:
JUDGE:
DEPT:
•
•
•
•
If there are any known related cases, file and serve a notice of related case. (You may use form CM-015.)
6.
b.
Other contract (37)
To keep other people from
seeing what you entered on
your form, please press the
Clear This Form button at the
end of the form when finished.
Auto (22)–Personal Injury/Property
Auto Tort
case involves an uninsured
motorist claim subject to
arbitration, check this item
instead of Auto)
Uninsured Motorist (46) (if the
Damage/Wrongful Death
INSTRUCTIONS ON HOW TO COMPLETE THE COVER SHEET
To Plaintiffs and Others Filing First Papers. If you are filing a first paper (for example, a complaint) in a civil case, you must
complete and file, along with your first paper, the Civil Case Cover Sheet contained on page 1. This information will be used to compile
statistics about the types and numbers of cases filed. You must complete items 1 through 6 on the sheet. In item 1, you must check
one box for the case type that best describes the case. If the case fits both a general and a more specific type of case listed in item 1,
check the more specific one. If the case has multiple causes of action, check the box that best indicates the primary cause of action.
To assist you in completing the sheet, examples of the cases that belong under each case type in item 1 are provided below. A cover
sheet must be filed only with your initial paper. Failure to file a cover sheet with the first paper filed in a civil case may subject a party,
its counsel, or both to sanctions under rules 2.30 and 3.220 of the California Rules of Court.
To Parties in Complex Cases
. In complex cases only, parties must also use the Civil Case Cover Sheet to designate whether the
case is complex. If a plaintiff believes the case is complex under rule 3.400 of the California Rules of Court, this must be indicated by
completing the appropriate boxes in items 1 and 2. If a plaintiff designates a case as complex, the cover sheet must be served with the
complaint on all parties to the action. A defendant may file and serve no later than the time of its first appearance a joinder in the
plaintiff's designation, a counter-designation that the case is not complex, or, if the plaintiff has made no designation, a designation that
the case is complex.
CASE TYPES AND EXAMPLES
Contract
Provisionally Complex Civil Litigation (Cal.
Rules of Court Rules 3.400–3.403)
Breach of Contract/Warranty (06)
Breach of Rental/Lease
Contract (not unlawful detainer
Antitrust/Trade Regulation (03)
Construction Defect (10)
Claims Involving Mass Tort (40)
Securities Litigation (28)
Environmental/Toxic Tort (30)
or wrongful eviction)
Contract/Warranty Breach–Seller
Plaintiff (not fraud or negligence)
Negligent Breach of Contract/
Warranty
Insurance Coverage Claims
Other Breach of Contract/Warranty
(arising from provisionally complex
case type listed above) (41)
Collections (e.g., money owed, open
Other PI/PD/WD (Personal Injury/
Property Damage/Wrongful Death)
Tort
book accounts) (09)
Collection Case–Seller Plaintiff
Asbestos (04)
Enforcement of Judgment
Other Promissory Note/Collections
Enforcement of Judgment (20)
Asbestos Property Damage
Case
Asbestos Personal Injury/
Insurance Coverage (not provisionally
Abstract of Judgment (Out of
Wrongful Death
complex) (18)
County)
Confession of Judgment (non-
Product Liability (not asbestos or
Auto Subrogation
toxic/environmental) (24)
domestic relations)
Other Coverage
Other Contract (37)
Medical Malpractice (45)
Sister State Judgment
Medical Malpractice–
Administrative Agency Award
Contractual Fraud
Physicians & Surgeons
(not unpaid taxes)
Petition/Certification of Entry of
Judgment on Unpaid Taxes
Other Contract Dispute
Other Professional Health Care
Malpractice
Real Property
Eminent Domain/Inverse
Other PI/PD/WD (23)
Other Enforcement of Judgment
Premises Liability (e.g., slip
Condemnation (14)
Case
and fall)
Wrongful Eviction (33)
Intentional Bodily Injury/PD/WD
Other Real Property (e.g., quiet title) (26)
Miscellaneous Civil Complaint
RICO (27)
(e.g., assault, vandalism)
Writ of Possession of Real Property
Mortgage Foreclosure
Intentional Infliction of
Other Complaint (not specified
above) (42)
Emotional Distress
Quiet Title
Negligent Infliction of
Declaratory Relief Only
Other Real Property (not eminent
domain, landlord/tenant, or
foreclosure)
Injunctive Relief Only (non-
Emotional Distress
Other PI/PD/WD
harassment)
Mechanics Lien
Non-PI/PD/WD (Other) Tort
Unlawful Detainer
Other Commercial Complaint
Business Tort/Unfair Business
Case (non-tort/non-complex)
Commercial (31)
Residential (32)
Practice (07)
Civil Rights (e.g., discrimination,
false arrest) (not civil
Other Civil Complaint
(non-tort/non-complex)
Drugs (38) (if the case involves illegal
drugs, check this item; otherwise,
report as Commercial or Residential)
Miscellaneous Civil Petition
harassment) (08)
Defamation (e.g., slander, libel)
Partnership and Corporate
(13)
Governance (21)
Judicial Review
Fraud (16)
Other Petition (not specified
Asset Forfeiture (05)
above) (43)
Intellectual Property (19)
Petition Re: Arbitration Award (11)
Civil Harassment
Professional Negligence (25)
Writ of Mandate (02)
Workplace Violence
Legal Malpractice
Other Professional Malpractice
(not medical or legal)
Other Non-PI/PD/WD Tort (35)
Writ–Administrative Mandamus
Writ–Mandamus on Limited Court
Elder/Dependent Adult
Abuse
Case Matter
Election Contest
Writ–Other Limited Court Case
Petition for Name Change
Review
Petition for Relief From Late
Employment
Claim
Other Judicial Review (39)
Wrongful Termination (36)
Other Employment (15)
Review of Health Officer Order
Notice of Appeal–Labor
Commissioner Appeals
Other Civil Petition
CM-010 [Rev. July 1, 2007]
Page 2 of 2
CIVIL CASE COVER SHEET
CM-010
To Parties in Rule 3.740 Collections Cases. A "collections case" under rule 3.740 is defined as an action for recovery of money
owed in a sum stated to be certain that is not more than $25,000, exclusive of interest and attorney's fees, arising from a transaction in
which property, services, or money was acquired on credit. A collections case does not include an action seeking the following: (1) tort
damages, (2) punitive damages, (3) recovery of real property, (4) recovery of personal property, or (5) a prejudgment writ of
attachment. The identification of a case as a rule 3.740 collections case on this form means that it will be exempt from the general
time-for-service requirements and case management rules, unless a defendant files a responsive pleading. A rule 3.740 collections
case will be subject to the requirements for service and obtaining a judgment in rule 3.740.
Print This Form
Clear This Form
For your protection and privacy, please press the Clear This Form
button after you have printed the form.
Approved for Optional Use
L-0115 (Rev. July 1, 2008)
PETITION FOR ALTERNATIVE WRIT OF MANDATE
CCP § 1094.5 AND VEHICLE CODE § 13559 TO SET
ASIDE SUSPENSION OF DRIVING PRIVILEGE – DUI
CCP 1094.5(g)
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name & Address):
Telephone No.: Fax No. (Optional):
E-Mail Address (Optional):
ATTORNEY FOR (Name): Bar No:
SUPERIOR COURT OF CALIFORNIA, COUNTY OF ORANGE
CENTRAL JUSTICE CENTER:
700 Civic Center Dr. West, Santa Ana, CA 92701
PETITIONER:
RESPONDENT: Director of the Department of Motor Vehicles
FOR COURT USE ONLY
PETITION FOR ALTERNATIVE WRIT OF MANDATE
CCP § 1094.5 AND VEHICLE CODE § 13559 TO SET
ASIDE SUSPENSION OF DRIVING PRIVILEGE - DUI
STAY REQUESTED
Unlimited Civil
CASE NUMBER:
Mark all
boxes that apply
1. Petitioner (full name),
,
is a resident of the County of Orange, State of California at the time this Petition is filed.
2. Respondent, Director of the Department of Motor Vehicles, is the Chief Executive Officer of the Department
of Motor Vehicles, a government agency of the State of California, hereafter referred to as “the DMV”.
3. On (date)
, per Vehicle Code 13382(a) and/or 23612(e), the arresting officer
served the petitioner with an Administrative Per Se Order of Suspension/Revocation Temporary License
Endorsement, a copy of which is attached to this petition.
4. Prior to the suspension of petitioner’s driver’s license, petitioner was the holder of a valid California driver’s
license number
issued by the DMV.
5. On (date)
, in the County of Orange, State of California, petitioner was
detained by a Peace Officer of the
California Highway Patrol.
Police Department.
County Sheriff’s Department.
Other (describe)
.
and, after arrest for violation of Vehicle Code § 23152 or 23153, was
administered a chemical test for blood alcohol concentration.
not administered a chemical test for blood alcohol concentration.
Page 1 of 3
Approved for Optional Use
L-0115 (Rev. July 1, 2008)
PETITION FOR ALTERNATIVE WRIT OF MANDATE
CCP § 1094.5 AND VEHICLE CODE § 13559 TO SET
ASIDE SUSPENSION OF DRIVING PRIVILEGE – DUI
CCP 1094.5(g)
PETITIONER:
RESPONDENT: Director of the Department of Motor Vehicles
CASE NUMBER:
6. Per Vehicle Code § 13380, the Officer then filed a sworn statement (Form DS-367) with the DMV stating
that there was reasonable cause to believe petitioner had been driving a motor vehicle in violation of
Vehicle Code § 23152 or 23153, the petitioner was arrested and petitioner
took a chemical test with a result of
% and % blood alcohol concentration.
did not take or complete a chemical test.
7. A copy of the Officer’s DS-367 Statement – Vehicle Code §§ 23152 and 13352 is attached to this petition.
8. On (date)
, petitioner requested an administrative hearing. The hearing was
granted and held on (date)
.
9. A certified copy of the transcript of the administrative hearing has been ordered from the DMV and
has been lodged with the Court.
will be lodged with the Court as soon as it is received by petitioner.
10. On (date)
, the DMV issued an Order of Suspension which stated that petitioner’s
privilege to drive a motor vehicle was suspended for year(s), from (date)
through (date) . The suspension was under the authority of Vehicle Code § 13353.3. A
copy of the Order of Suspension is attached to this petition.
11. This petition is further based on the following evidence and matters from the record of the administrative
hearing [attach additional pages if necessary].
12. Petitioner is beneficially interested in this action because petitioner is a party directly affected by the action
of Respondent in suspending his or her privilege to operate a motor vehicle.
Page 2 of 3
Approved for Optional Use
L-0115 (Rev. July 1, 2008)
PETITION FOR ALTERNATIVE WRIT OF MANDATE
CCP § 1094.5 AND VEHICLE CODE § 13559 TO SET
ASIDE SUSPENSION OF DRIVING PRIVILEGE – DUI
CCP 1094.5(g)
PETITIONER:
RESPONDENT: Director of the Department of Motor Vehicles
CASE NUMBER:
13. Petitioner needs his or her license
to drive to and from and in connection with his or her employment, as well as personal needs.
to engage in business for his or her livelihood.
Unless the Order of the DMV is stayed, he or she will suffer irreparable damage and injury.
14. As required by California Rule of Court, rule 3.1142, a copy of petitioner’s driving record from the DMV is
attached to this petition.
15. Petitioner does not have a speedy and adequate remedy at law because there is no appeal from
respondent’s order suspending the privilege to operate a motor vehicle. Petitioner’s only method of review
of that order is by writ of mandate in this Court.
16. Petitioner’s privilege to operate a motor vehicle is not suspended or revoked for any reason other than
those stated in this petition.
Petitioner prays that:
1. An alternative writ of mandate issue under the seal of the Court commanding respondent Director of the
DMV to set aside and revoke the DMV’s suspension of petitioner’s driving privilege or to show cause before
the Court at a time and place to be specified by the Court why it has not done so, and why a peremptory
writ should not issue.
2. Pending the hearing and final judgment of the Court in this matter, the DMV be ordered to stay the
operation of the order suspending Petitioner’s driving privilege.
3. Other (Describe):
4. For such and further relief as the Court may deem proper.
Dated:
(Type or Print Name) (Signature of Petitioner)
VERIFICATION
STATE OF CALIFORNIA)
COUNTY OF ORANGE) ss.
I, the undersigned, declare under penalty of perjury under the laws of the State of California that the foregoing is
true and correct.
Executed on (date)
at , California.
(Signature of Petitioner)
Page 3 of 3
For your protection and privacy, please press the Clear
This Form button after you are done printing the form.
Clear This Form
L89 (New January 1, 2006)
ALTERNATIVE WRIT OF MANDATE ORDER
AND ORDER TO SHOW CAUSE - DUI
CCP 1094.5(g)
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name & Address):
Telephone No.: Fax No. (Optional):
E-Mail Address (Optional):
ATTORNEY FOR (Name): Bar No:
SUPERIOR COURT OF CALIFORNIA, COUNTY OF ORANGE
CENTRAL JUSTICE CENTER:
700 Civic Center Dr. West, Santa Ana, CA 92701
PETITIONER:
RESPONDENT: Director of the Department of Motor Vehicles
FOR COURT USE ONLY
ALTERNATIVE WRIT OF MANDATE ORDER
AND ORDER TO SHOW CAUSE - DUI
Unlimited Civil
CASE NUMBER:
To the Director of the Department of Motor Vehicles and the Department of Motor Vehicles, hereafter referred to as
“the DMV”:
You are ordered to set aside and revoke the DMV’s suspension of the petitioner’s driving privilege commencing
(date)
through (date) or, in the alternative, to show cause why
you have not done so and appear for hearing on a Writ of Mandate on (date)
at (time)
or as soon thereafter as the matter may be heard in Department of the above entitled
Court.
Petitioner is ordered to serve on respondent written notice of the time and place of the hearing with a copy of the
petition, the papers on which the petition is based and this Order at least 16 court days prior to the date of the
hearing if service is personal, and an additional 5 calendar days if service is by mail.
Dated:
Judge/Commissioner
Approved for Optional Use
L-0274 (Rev. July 1, 2008)
ORDER STAYING SUSPENSION – DUI
CCP 1094.5(g)
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name & Address):
Telephone No.: Fax No. (Optional):
E-Mail Address (Optional):
ATTORNEY FOR (Name): Bar No:
SUPERIOR COURT OF CALIFORNIA, COUNTY OF ORANGE
CENTRAL JUSTICE CENTER:
700 Civic Center Dr. West, Santa Ana, CA 92701
PETITIONER:
RESPONDENT: Director of the Department of Motor Vehicles
FOR COURT USE ONLY
ORDER STAYING SUSPENSION - DUI
Unlimited Civil
CASE NUMBER:
The suspension of petitioner’s license is stayed until the ruling on the petition for Writ of Mandate.
The following conditions apply to this Order:
Petitioner is not to consume any alcoholic beverages within 12 hours prior to driving.
Petitioner is only to drive to and from school or work.
Other:
Dated:
Judge/Commissioner
For your protection and privacy, please press the Clear
This Form button after you are done printing the form.
Clear This Form
American LegalNet, Inc.
www.FormsWorkflow.com
FOR COURT USE ONLY
ATTORNEY FOR (Name):
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
CASE NUMBER:
TELEPHONE NO.:
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address):
FAX NO. (Optional):
POS-040
PROOF OF SERVICE—CIVIL
E-MAIL ADDRESS (Optional):
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
By Mail
By Personal Service
By Messenger Service By Fax
By Overnight Delivery
By Electronic Service
At the time of service I was over 18 years of age and not a party to this action.
My residence or business address is:
On (date): I served the following documents (specify):
I served the documents on the person or persons below, as follows:
a. Name of person served:
b. (Complete if service was by personal service, mail, overnight delivery, or messenger service.)
PROOF OF SERVICE—CIVIL
Code of Civil Procedure., §§ 1010.6, 1011, 1013, 1013a,
2015.5; Cal. Rules of Court, rules 2.260, 2.306
www.courtinfo.ca.gov
Form Approved for Optional Use
Judicial Council of California
POS-040 [Rev. January 1, 2009]
The documents were served by the following means (specify):
By personal service. I personally delivered the documents to the persons at the addresses listed in item 5. (1) For a
party represented by an attorney, delivery was made to the attorney or at the attorney's office by leaving the documents,
in an envelope or package clearly labeled to identify the attorney being served, with a receptionist or an individual in
charge of the office, between the hours of nine in the morning and five in the evening. (2) For a party, delivery was made
to the party or by leaving the documents at the party's residence with some person not younger than 18 years of age
between the hours of eight in the morning and six in the evening.
JUDGE:
DEPT.:
(Do not use this proof of service to show service of a Summons and complaint.)
Check method of service (only one):
The documents are listed in the Attachment to Proof of Service–Civil (Documents Served) (form POS-040(D)).
Fax number or electronic notification address where person was served:
Time of service:
The names, addresses, and other applicable information about persons served is on the Attachment to Proof of
Service—Civil (Persons Served) (form POS-040(P)).
PLAINTIFF/PETITIONER:
DEFENDANT/RESPONDENT
:
(Proof of Service)
The fax number or electronic notification address from which I served the documents is (complete if service was by fax or
electronic service):
3.
4.
5.
(1)
c.
6.
Business or residential address where person was served:
a.
(Complete if service was by fax or electronic service.)
(2)
(Continued on back)
1.
2.
To keep other people from
seeing what you entered on
your form, please press the
Clear This Form button at the
end of the form when finished.
CASE NAME
CASE NUMBER:
b. By United States mail. I enclosed the documents in a sealed envelope or package addressed to the persons at the
addresses in item 5 and (specify one):
(1) deposited the sealed envelope with the United States Postal Service, with the postage fully prepaid.
(2) placed the envelope for collection and mailing, following our ordinary business practices. I am readily familiar
with this business's practice for collecting and processing correspondence for mailing. On the same day that
correspondence is placed for collection and mailing, it is deposited in the ordinary course of business with the
United States Postal Service, in a sealed envelope with postage fully prepaid.
c. By overnight delivery. I enclosed the documents in an envelope or package provided by an overnight delivery
carrier and addressed to the persons at the addresses in item 5. I placed the envelope or package for collection
and overnight delivery at an office or a regularly utilized drop box of the overnight delivery carrier.
d. By messenger service. I served the documents by placing them in an envelope or package addressed to the persons
at the addresses listed in item 5 and providing them to a professional messenger service for service. (A declaration by
the messenger must accompany this Proof of Service or be contained in the Declaration of Messenger below.)
By fax transmission. Based on an agreement of the parties to accept service by fax transmission, I faxed the documents
to the persons at the fax numbers listed in item 5. No error was reported by the fax machine that I used. A copy of the
record of the fax transmission, which I printed out, is attached.
By electronic service. Based on a court order or an agreement of the parties to accept service by electronic transmission,
I caused the documents to be sent to the persons at the electronic notification addresses listed in item 5. I did not receive,
within a reasonable time after the transmission, any electronic message or other indication that the transmission was
unsuccessful.
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Date:
(TYPE OR PRINT NAME OF DECLARANT)
(SIGNATURE OF DECLARANT)
DECLARATION OF MESSENGER
By personal service. I personally delivered the envelope or package received from the declarant above to the persons at the
addresses listed in item 5. (1) For a party represented by an attorney, delivery was made to the attorney or at the attorney's
office by leaving the documents in an envelope or package, which was clearly labeled to identify the attorney being served,
with a receptionist or an individual in charge of the office, between the hours of nine in the morning and five in the evening. (2)
For a party, delivery was made to the party or by leaving the documents at the party's residence with some person not younger
than 18 years of age between the hours of eight in the morning and six in the evening.
PROOF OF SERVICE—CIVIL
POS-040 [Rev. January 1, 2009]
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Date:
(NAME OF DECLARANT)
(SIGNATURE OF DECLARANT)
`
___________________________________________
`______________________________________
___________________________________________
(If item 6d above is checked, the declaration below must be completed or a separate declaration from a messenger must be attached.)
I am a resident or employed in the county where the mailing occurred. The envelope or package was placed in the mail at
(city and state):
(Proof of Service)
__________________________________________
e.
f.
6.
At the time of service, I was over 18 years of age. I am not a party to the above-referenced legal proceeding.
I served the envelope or package, as stated above, on (date):
POS-040
INFORMATION SHEET FOR PROOF OF SERVICE—CIVIL
USE OF THIS FORM
This form is designed to be used to show proof of service of documents by (1) personal service, (2) mail, (3) overnight
delivery, (4) messenger service, (5) fax, or (6) electronic transmission.
Note: This proof of service form should not be used to show proof of service of a summons and complaint. For that
purpose, use Proof of Service of Summons (form POS-010).
A person must be over 18 years of age to serve the documents. The person who served the documents must complete
the Proof of Service. A party to the action cannot serve the documents.
Second box, left side
: Print the name of the county in which the legal action is filed and the court's address in this box.
The address for the court should be the same as the address on the documents that you served.
Third box, right side:
State the judge and department assigned to the case, if known.
First box, top of form, right side
: Leave this box blank for the court’s use.
Complete items 1–6:
You are stating that you are over the age of 18 and that you are not a party to this action.
Print your home or business address.
List each document that you served. If you need more space, check the box in item 4, complete the Attachment to
Proof of Service—Civil (Documents Served) (form POS-040(D)), and attach it to form POS-040.
Provide the names, addresses, and other applicable information about the persons served. If more than one
person was served, check the box on item 5, complete the Attachment to Proof of Service—Civil (Persons Served)
(form POS-040(P)), and attach it to form POS-040.
Check the box before the method of service that was used, and provide any additional information that is required.
You must sign and date the proof of service form. By signing, you are stating under penalty of perjury that the
information that you have provided on form POS-040 is true and correct.
PROOF OF SERVICE—CIVIL
POS-040 [Rev. January 1, 2009]
GENERAL INSTRUCTIONS
Second box, right side
: Print the case number in this box. The case number should be the same as the case number
on the documents that you served.
2.
1.
4.
5.
(This information sheet is not part of the official proof of service form and does not need to be copied, served, or filed.)
Certain documents must be personally served. For example, an order to show cause and temporary restraining order
generally must be served by personal delivery. You must determine whether a document must be personally delivered
or can be served by mail or another method.
Complete the top section of the proof of service form as follows:
The law may require that documents be served in a particular manner (such as by personal delivery) for certain
purposes. Service by fax or electronic transmission generally requires the prior agreement of the parties.
Fourth box, left side:
Check the method of service that was used. You should check only one method of service and
should show proof of only one method on the form. If you served a party by several methods, use a separate form
to show each method of service.
Third box, left side
: Print the names of the plaintiff/petitioner and defendant/respondent in this box. Use the same
names as are on the documents that you served.
First box, left side
: In this box print the name, address, and telephone number of the person for whom you served the
documents.
The Proof of Service should be typed or printed. If you have Internet access, a fillable version of this proof of service
form is available at www.courtinfo.ca.gov/forms.
6.
(Proof of Service)
If service was by fax service or electronic service, print the fax number or electronic notification address from which
service was made.
3.
POS-040
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PETITION FOR ALTERNATIVE WRIT OF MANDATE TO SET (The Superior Court of California - County of Orange)

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Completed 8 February 2021

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