Application To Be Relieved As Council Page 2

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FL-955
PETITIONER/PLAINTIFF:
CASE NUMBER:
RESPONDENT/DEFENDANT:
OTHER PARENT/CLAIMANT:
PROOF OF SERVICE BY
PERSONAL SERVICE
MAIL
1. At the time of service I was at least 18 years of age and not a party to this legal action.
2. I served a copy of the completed Application to Be Relieved as Counsel Upon Completion of Limited Scope Representation and all
attachments as well as a blank Objection to Application to Be Relieved as Counsel Upon Completion of Limited Scope
Representation as follows (check either a. or b. below):
a.
Personal service. I personally delivered the forms listed above and any attachments as follows:
(1) Name of person served:
(2) Address where served:
(3) Date served:
(4) Time served:
b.
Mail. I placed copies of the forms listed above in a sealed envelope with postage fully prepaid. The envelope was
addressed and mailed as follows:
(1) Name of person served:
(2) Address:
(3) Date of mailing:
(4) Place of mailing (city and state):
(5) I live in or work in the county where the forms were mailed.
3. Server’s information:
a. Name:
b. Home or work address:
c. Telephone number:
I declare under penalty of perjury under the laws of the State of California that the information above is true and correct.
Date:
(TYPE OR PRINT SERVER’S NAME)
(SERVER TO SIGN HERE)
FL-955 [Rev. January 1, 2007]
APPLICATION TO BE RELIEVED AS COUNSEL
Page 2 of 2
UPON COMPLETION OF LIMITED SCOPE REPRESENTATION
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.

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