Fillable Printable Sample Form for Proof of Service
Fillable Printable Sample Form for Proof of Service
Sample Form for Proof of Service
FOR COURT USE ONLY
ATTORNEY FOR (Name):
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
CASE NUMBER:
TELEPHONE NO.:
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address):
FAX NO. (Optional):
POS-040
PROOF OF SERVICE—CIVIL
E-MAIL ADDRESS (Optional):
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
By MailBy Personal Service
By Messenger Service By Fax
By Overnight Delivery
By Electronic Service
At the time of service I was over 18 years of age and not a party to this action.
My residence or business address is:
On (date): I served the following documents (specify):
I served the documents on the person or persons below, as follows:
a. Name of person served:
b. (Complete if service was by personal service, mail, overnight delivery, or messenger service.)
PROOF OF SERVICE—CIVIL
Code of Civil Procedure, §§ 1010.6, 1011, 1013, 1013a,
2015.5; Cal. Rules of Court, rules 2.260, 2.306
Form Approved for Optional Use
Judicial Council of California
The documents were served by the following means (specify):
By personal service. I personally delivered the documents to the persons at the addresses listed in item 5. (1) For a
party represented by an attorney, delivery was made to the attorney or at the attorney's office by leaving the documents,
in an envelope or package clearly labeled to identify the attorney being served, with a receptionist or an individual in
charge of the office, between the hours of nine in the morning and five in the evening. (2) For a party, delivery was made
to the party or by leaving the documents at the party's residence with some person not younger than 18 years of age
between the hours of eight in the morning and six in the evening.
JUDGE:
DEPT.:
(Do not use this proof of service to show service of a Summons and complaint.)
Check method of service (only one):
The documents are listed in the Attachment to Proof of Service–Civil (Documents Served) (form POS-040(D)).
Fax number or electronic service address where person was served:
Time of service:
The names, addresses, and other applicable information about persons served is on the Attachment to Proof of
Service—Civil (Persons Served) (form POS-040(P)).
PLAINTIFF/PETITIONER:
DEFENDANT/RESPONDENT:
(Proof of Service)
The fax number or electronic service address from which I served the documents is (complete if service was by fax or
electronic service):
3.
4.
5.
(1)
c.
6.
Business or residential address where person was served:
a.
(Complete if service was by fax or electronic service.)
(2)
1.
2.
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CASE NAME:
CASE NUMBER:
b. By United States mail. I enclosed the documents in a sealed envelope or package addressed to the persons at the
addresses in item 5 and (specify one):
(1) deposited the sealed envelope with the United States Postal Service, with the postage fully prepaid.
(2) placed the envelope for collection and mailing, following our ordinary business practices. I am readily familiar
with this business's practice for collecting and processing correspondence for mailing. On the same day that
correspondence is placed for collection and mailing, it is deposited in the ordinary course of business with the
United States Postal Service, in a sealed envelope with postage fully prepaid.
c. By overnight delivery. I enclosed the documents in an envelope or package provided by an overnight delivery
carrier and addressed to the persons at the addresses in item 5. I placed the envelope or package for collection
and overnight delivery at an office or a regularly utilized drop box of the overnight delivery carrier.
d. By messenger service. I served the documents by placing them in an envelope or package addressed to the persons
at the addresses listed in item 5 and providing them to a professional messenger service for service. (A declaration by
the messenger must accompany this Proof of Service or be contained in the Declaration of Messenger below.)
By fax transmission. Based on an agreement of the parties to accept service by fax transmission, I faxed the documents
to the persons at the fax numbers listed in item 5. No error was reported by the fax machine that I used. A copy of the
record of the fax transmission, which I printed out, is attached.
By electronic service. Based on a court order or an agreement of the parties to accept electronic service, I caused the
documents to be sent to the persons at the electronic service addresses listed in item 5.
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 OF DECLARANT) (SIGNATURE OF DECLARANT)
DECLARATION OF MESSENGER
By personal service. I personally delivered the envelope or package received from the declarant above to the persons at the
addresses listed in item 5. (1) For a party represented by an attorney, delivery was made to the attorney or at the attorney's
office by leaving the documents in an envelope or package, which was clearly labeled to identify the attorney being served,
with a receptionist or an individual in charge of the office, between the hours of nine in the morning and five in the evening. (2)
For a party, delivery was made to the party or by leaving the documents at the party's residence with some person not younger
than 18 years of age between the hours of eight in the morning and six in the evening.
PROOF OF SERVICE—CIVIL
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Date:
(NAME OF DECLARANT)
(SIGNATURE OF DECLARANT)
___________________________________________
______________________________________
___________________________________________
(If item 6d above is checked, the declaration below must be completed or a separate declaration from a messenger must be attached.)
I am a resident or employed in the county where the mailing occurred. The envelope or package was placed in the mail at
(city and state):
(Proof of Service)
__________________________________________
e.
f.
6.
At the time of service, I was over 18 years of age. I am not a party to the above-referenced legal proceeding.
I served the envelope or package, as stated above, on (date):
POS-040
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INFORMATION SHEET FOR PROOF OF SERVICE—CIVIL
USE OF THIS FORM
This form is designed to be used to show proof of service of documents by (1) personal service, (2) mail, (3) overnight
delivery, (4) messenger service, (5) fax, or (6) electronic transmission.
Note: This proof of service form should not be used to show proof of service of a summons and complaint. For that
purpose, use Proof of Service of Summons (form POS-010).
A person must be over 18 years of age to serve the documents. The person who served the documents must complete
the Proof of Service. A party to the action cannot serve the documents.
Second box, left side: Print the name of the county in which the legal action is filed and the court's address in this box.
The address for the court should be the same as the address on the documents that you served.
Third box, right side: State the judge and department assigned to the case, if known.
First box, top of form, right side: Leave this box blank for the court’s use.
Complete items 1–6:
You are stating that you are over the age of 18 and that you are not a party to this action.
Print your home or business address.
List each document that you served. If you need more space, check the box in item 4, complete the Attachment to
Proof of Service—Civil (Documents Served) (form POS-040(D)), and attach it to form POS-040.
Provide the names, addresses, and other applicable information about the persons served. If more than one
person was served, check the box on item 5, complete the Attachment to Proof of Service—Civil (Persons Served)
(form POS-040(P)), and attach it to form POS-040.
Check the box before the method of service that was used, and provide any additional information that is required.
You must sign and date the proof of service form. By signing, you are stating under penalty of perjury that the
information that you have provided on form POS-040 is true and correct.
PROOF OF SERVICE—CIVIL
GENERAL INSTRUCTIONS
Second box, right side: Print the case number in this box. The case number should be the same as the case number
on the documents that you served.
2.
1.
4.
5.
(This information sheet is not part of the official proof of service form and does not need to be copied, served, or filed.)
Certain documents must be personally served. For example, an order to show cause and temporary restraining order
generally must be served by personal delivery. You must determine whether a document must be personally delivered
or can be served by mail or another method.
Complete the top section of the proof of service form as follows:
The law may require that documents be served in a particular manner (such as by personal delivery) for certain
purposes. Service by fax or electronic transmission generally requires the prior agreement of the parties.
Fourth box, left side: Check the method of service that was used. You should check only one method of service and
should show proof of only one method on the form. If you served a party by several methods, use a separate form
to show each method of service.
Third box, left side: Print the names of the plaintiff/petitioner and defendant/respondent in this box. Use the same
names as are on the documents that you served.
First box, left side: In this box print the name, address, and telephone number of the person for whom you served the
documents.
The Proof of Service should be typed or printed. If you have Internet access, a fillable version of this proof of service form
is available at www.courts.ca.gov/forms.htm.
6.
(Proof of Service)
If service was by fax service or electronic service, print the fax number or electronic service address from which service
was made.
3.
POS-040
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