
POS-010
Page 1 of 2
Form Adopted for Mandatory Use
Judicial Council of California
POS-010 [Rev. January 1, 2007]
PROOF OF SERVICE OF SUMMONS
Code of Civil Procedure, § 417.10
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ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address):
TELEPHONE NO.: FAX NO. (Optional):
E-MAIL ADDRESS (Optional):
ATTORNEY FOR (Name):
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
FOR COURT USE ONLY
PLAINTIFF/PETITIONER:
DEFENDANT/RESPONDENT:
CASE NUMBER:
PROOF OF SERVICE OF SUMMONS
Ref. No. or File No.:
(Separate proof of service is required for each party served.)
1. At the time of service I was at least 18 years of age a
nd not a party to this action.
2. I served copies of:
a.
summons
b.
complaint
c.
Alternative Dispute Resolution (ADR) package
d.
Civil Case Cover Sheet (served in complex cases only)
e.
cross-complaint
f. other (specify documents):
3. a. Party served (specify name of party as shown on documents served):
b.
Person (other than the party in item 3a) served on behalf of an entity or as an authorized agent (and not a person
under item 5b on whom substituted service was made) (specify name and relationship to the party named in item 3a):
4. Address where the party was served:
5. I served the party (check proper box)
a.
by personal service. I personally delivered the documents listed in item 2 to the party or person authorized to
receive service of process for the party (1) on (date): (2) at (time):
b. by substituted service. On (date): at (time):
I left the documents listed in item 2 with or
in the presence of (name and title or relationship to person indicated in item 3):
(1)
(business) a person at least 18 years of age apparently in charge at the office or usual place of business
of the person to be served. I informed him or her of the general nature of the papers.
(2)
(home) a competent member of the household (at least 18 years of age) at the dwelling house or usual
place of abode of the party. I informed him or her of the general nature of the papers.
(3) (physical address unknown) a person at least 18 years of age apparently in charge at the usual mailing
address of the person to be served, other than a United States Postal Service post office box. I informed
him or her of the general nature of the papers.
(4)
I thereafter mailed (by first-class, postage prepaid) copies of the documents to the person to be served
at the place where the copies were left (Code Civ. Proc., § 415.20). I mailed the documents on
(date):
from (city): or
a declaration of mailing is attached.
(5) I attach a declaration of diligence stating actions taken first to attempt personal service.