California Superior Court Forms Proof Of Service Of Summons Page 2
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1
2CASE 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):
with two copies of the Notice and Acknowledgment of Receipt (form FL-117) and a postage-paid return
(1)
envelope addressed to me. (Attach completed Notice and Acknowledgment of Receipt (form FL-117).)
(Code Civ. Proc., § 415.30.)
to an address outside California (by registered or certified mail with return receipt requested). (Attach signed
(2)
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)
5.
Person who served papers
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)
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