Form F 701 - Request For Assignment To Mediation Program Page 4
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4PROOF OF SERVICE OF DOCUMENT
I am over the age of 18 and not a party to this bankruptcy case or adversary proceeding. My business address is:
A true and correct copy of the foregoing document described as REQUEST FOR ASSIGNMENT TO MEDIATION
PROGRAM will be served or was served (a) on the judge in chambers in the form and manner required by LBR 5005-
2(d); and (b) in the manner stated below:
1. TO BE SERVED BY THE COURT VIA NOTICE OF ELECTRONIC FILING (NEF): Pursuant to controlling General
Order(s) and LBR, the foregoing document will be served by the court via NEF and hyperlink to the document. On
____________________, I checked the CM/ECF docket for this bankruptcy case or adversary proceeding and
determined that the following person(s) are on the Electronic Mail Notice List to receive NEF transmission at the email
address(es) stated below:
Service information continued on attached page
2. SERVED BY UNITED STATES MAIL OR OVERNIGHT MAIL (state method for each person or entity served):
On __________________________, I served the following person(s) and/or entity(ies) at the last known address(es) in
this bankruptcy case or adversary proceeding by placing a true and correct copy thereof in a sealed envelope in the
United States mail, first class, postage prepaid, and/or with an overnight mail service addressed as follows. Listing the
judge here constitutes a declaration that mailing to the judge will be completed no later than 24 hours after the document
is filed.
Mediator:
Alternate Mediator:
Service information continued on attached page
3. SERVED BY PERSONAL DELIVERY, FACSIMILE TRANSMISSION OR EMAIL (state method for each person or
entity served): Pursuant to F.R.Civ.P. 5 and/or controlling LBR, on ______________________, I served the following
person(s) and/or entity(ies) by personal delivery, or (for those who consented in writing to such service method), by
facsimile transmission and/or email as follows. Listing the judge here constitutes a declaration that personal delivery on
the judge will be completed no later than 24 hours after the document is filed.
Service information continued on attached page
I declare under penalty of perjury under the laws of the United States that the foregoing is true and correct.
Date:___________________________
Signature:_______________________________________
Printed Name:____________________________________
This form is mandatory. It has been approved for use in the United States Bankruptcy Court for the Central District of California.
F 701
May 2011
Page 4
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