California Preliminary Notice Form/proof Of Notice Declaration Page 2

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PROOF OF NOTICE DECLARATION

I, ____________________________________________, declare that I served copies of the Preliminary Notice on each of the parties at the addresses and

on the dates shown below:

Construction Lender: (name) ____________________________________________ (title) ____________________________________

(address) ___________________________________________________________________________________

(date)__________________________________________

Owner or Public Entity: (name) _________________________________________(title) _______________________________________

(address) _____________________________________________________________________________________

(date)__________________________________________

Original Contractor: (name) ___________________________________________ (title) _______________________________________

(address) _____________________________________________________________________________________

(date)__________________________________________

In the following manner (check appropriate box):

[ ] By personal delivery

[ ] By Registered or Certified Mail (postage prepaid)

[ ] Express mail

[ ] Overnight delivery by ___________________________________, an express service carrier

[ ] By leaving the Preliminary Notice with:

[ ] (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/her of the general nature of the papers.

[ ] (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/her of the general nature of the papers.

[ ] (physical address) 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/her of the general nature of the papers.

[ ] 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.

I declare under penalty of perjury, that the foregoing is true and correct. Executed on _______________________, at _____________________, California.

_____________________________

(Signature of person making service)

C&B Revised 7-1-2012