CASE NUMBER:
PETITIONER:
RESPONDENT:
3. b. (cont.)
on (date):
at (time):
I thereafter mailed additional copies (by first class, postage prepaid) to the respondent at the place where the
copies were left (Code Civ. Proc., § 415.20b) on (date):
A declaration of diligence is attached, stating the actions taken to first attempt personal service.
c.
Mail and acknowledgment service. I mailed the copies to the respondent, addressed as shown in item 2, by
first-class mail, postage prepaid,
on (date):
from (city):
(1)
with two copies of the Notice and Acknowledgment of Receipt (form FL-117) and a postage-paid return
envelope addressed to me. (Attach completed Notice and Acknowledgment of Receipt (form FL-117).)
(Code Civ. Proc., § 415.30.)
(2)
to an address outside California (by registered or certified mail with return receipt requested). (Attach signed
return receipt or other evidence of actual delivery to the respondent.) (Code Civ. Proc., § 415.40.)
Other (specify code section):
d.
Continued on Attachment 3d.
4. The "NOTICE TO THE PERSON SERVED" on the Summons was completed as follows (Code Civ. Proc., §§ 412.30, 415.10, 474):
a.
As an individual
or
b.
On behalf of respondent who is a
(1)
minor. (Code Civ. Proc., § 416.60.)
(2)
ward or conservatee. (Code Civ. Proc., § 416.70.)
other (specify):
(3)
Person who served papers
5.
Name:
Address:
Telephone number:
This person is
a.
exempt from registration under Business and Professions Code section 22350(b).
b.
not a registered California process server.
c.
a registered California process server:
an employee or
an independent contractor
(1) Registration no.:
(2)
County:
d.
The fee for service was (specify): $
6.
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
–or–
7.
I am a California sheriff, marshal, or constable, and I certify that the foregoing is true and correct.
Date:
(NAME OF PERSON WHO SERVED PAPERS)
(SIGNATURE OF PERSON WHO SERVED PAPERS)
FL-115 [Rev. July 1, 2012]
Page 2 of 2
PROOF OF SERVICE OF SUMMONS
(Family Law—Uniform Parentage—Custody and Support)
For your protection and privacy, please press the Clear This Form
Save This Form
Print This Form
Clear This Form
button after you have printed the form.