Sample Form C Proof Of Service Page 4
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4PROOF OF SERVICE BY MAIL
CASE NAME: _________________________________________________________
COURT OF APPEAL CASE NUMBER: _____________________________________
SUPERIOR COURT CASE NUMBER: ______________________________________
I, ____________________________ (specify name of person doing service), declare as follows:
1. At the time of service, I was at least 18 years of age and not a party to this legal action. I am
a resident or employed in the county where the within-mentioned service occurred.
2. My residence or business address is (specify):
__________________________
__________________________
__________________________ ___ residence ___ business
3. On __________ (specify date), I served the _________________________________ (specify
document) by United States mail as follows: I enclosed a copy in separate envelopes, with
postage fully prepaid, addressed to each individual addressee named below, and I deposited each
sealed envelope with the United States Postal Service in _________________, California, for
delivery as follows:
_____________________________
California Supreme Court
_____________________________
350 McAllister Street
_____________________________
San Francisco, CA 94102
(List addresses and send 1 copy to
(4 copies of briefs only)
each party)
_________________ Superior Court
___________________________
_____________________________
___________________________
_____________________________
___________________________
(List address of Superior Court and
(List address of any public officer
serve 1 copy of briefs only)
or agency required to be served by
CRC rule 8.29 and serve 1 copy of
briefs only)
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)
(SIGNATURE OF DECLARANT)
Sample Form C
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