Proof of Service Summons DLR CivilCal. Super. - 6th Dist.April 6, 2021POS-010 A'ITORN OR PARTY OUTWAfiisNflName State Barnumber. and address): FOR COURT USE ONLY CD?(bggn/eoadfiw ELE[gm Job; 0r 457/6 TELEPHONE No; g , FAX N0 (Optionar) E-MAIL ADDRessmprr'onaa-M 777 fl’g/I‘M AHORNEY FORmamo): (a SEP 2 7 2021 SUPERIOR COURT 0F CALIFORN!A, COUNTY OF STREET ADDRESS: 191 N. Flrst St Clerk Of he Court r un o! CA u nta C!MAILING ADDRESS. San Jubve’ CA 95 11 3 aw __ ___ Ea?”CITY AND ZIP cooE; ‘- BRANCH NAME: PLAINTIFF/PETITIONERzmrEj W/wéjfi eAsE NUMBER: DEFENDANT/RESPONDENT: 7‘." MpéI/é Z é /4a”74,5 07/61/579/5-a Rel. No‘ orFlle No; PROOF OF SERVICE OF SUMMONS (Separate proof of service is required for each pan‘y served.) 1. At the time of service | was at least 18 years of age and not a party to this action. 2. | served opies of: fl summons complaint Alternative Dispute Resolution (ADR) package Civil Case Cover Sheet (served in complex cases only)BEBE cross-complaint a b c. d e f E other (specify documents): 5" m . Party served (specify name ofparty as shown on documents served): 7:m oéf/e’ b.E Person (other than the party in item 3a) served 0n behalf ofan entity or a's an authorized agent (and not a person under item 5b on whom substituted service was ma e) (specify name and reiationship to the pan‘y named in item 3a): ex f- 4. Address where the party was servedzgw 35" 139 nc/ 4J5 fle/flm/ab) u/A' ?J/flpa' 5. | served the party (check proper box) a. D by personal service. l personally delivered the documents listed in item 2 to the party or person authorized to receive service of process for the party (1) on (date): (2) at (time): b. E by substituted servlce. On (date): at (time): | left the documents listed in item 2 with 0r in the presence of {name and title or relationship to person indicated in item 3): (1) E (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. | informed him or her of the general nature of the papers. (2) D (home) a competent member of the household (at least 18 years of age) at the dwelling house or usual place ofabode oflhe party. I informed him or her of the general nature 0f the papers. (3) E (physical address unknown) a person at least 18 years of age apparently in charge at the usual mailing address ofthe person to be served, other than a United States Postal Service post office box. I informed him or her ofthe general nature ofthe papers. (4) E | thereafter mailed (by first-class, postage prepaid) copies ofthe documents to the person to be served at the place where the copies were left (Code Civ. Proc.. § 415 20. | mailed the documents on (date): from (city). or a declaration of mailing'Is attached. (5) E l attach a declaration of diligence stating actions taken first to attempt personal service. Page1 012 Form .jAdpptedfor. Mandamry Use PROOF 0F SERVICE OF SUMMONS Code afclvil Procedure. 5417.10Judwual Councll o! Cahfornla POS-O1D [Rav.January 1. 2007'] I . l' ~ I PLAINTIFF/PETITIONERmQrEj ééfifla‘wmfi. DEFENDANT/RESPONDENT: "7: mo é,/a, 5' c. by mail and acknowledgment of receipt of service. | mailed the documents listed in item 2 to the party. to the address shown in item 4, by first-class mail, postage prepaid, (1) on (date): . (2) from (city): ' Q) with two copies 0f the Notice andAcknow/edgment ofReceipt and a postage-paid return envelope addressed to me. (Attach completed Notice and Acknowledgement 0f Receipt.) (Code Civ. Proc.. § 415.30.) (4) E to an address outside California with return receipt requested. (Code Civ. Proc.. § 415.40.) d, E by other means (specify means of sewice and authorizing code section): E Additional page describing service is attached. 6. The "Notice to the Person Served" (on the summons) was completed as follows: a. E as an individual defendant. b- E as the person sued under the fictitious name of (specify): 0‘ as occupant. d- % 0n behalf of (specim- , under the following Code of Civil Procedure section: E 416.10 (corporation) g 415.95 (business organization. form unknown)E 416.20 (defunctcorporation) 416,60 (minor)E 416.30 (joint stock company/association) a 416.70 (ward or conservatee)E 41 6.40 (association or partnership) a 416.90 (authorized person) E 416.50 (public entity) [II 415.46(occupant)E other: 7. Person who served papers a. Namefinryw‘v PDSJ’W’{ Addresszll7 jymfi/ m1 #70b. c. Telephone number: (.[og’ $739 ”(VG yo d. The fee forservice was: $UTO 0 e. I am: (1) not a registered California process sewer. (2) exempt from registration under Business and Professions Code section 22350(b). (3) a registered California process server: (i) E owner E employee E independent contractor. (ii) Registration No.: (iii) County: 8. Ideclare under penalty 0f perjury under the laws of the State of California that the forpgoing is true and correct. or 9. D lam a California sheriff or marshal and lcenify that the foregoing is true and correct. Date: 9/971/909/ 0 fl>\ a Um” 4‘ (NAME 0F PERSON WHO SERVED PAPERS/SHERIFF 0R MARSHAL) a lé’IGNKmRE’) Pagn 2 o! 2P0501" “Re“‘Ja“”a”"2°°" PROOF 0F SERVICE 0F SUMMONS “S‘ssew-J ‘ Wé i ; El Complete Items 1. 2, and 3. " U Print your name and address on the reverse sb that we can return the card to you. E u Attach this card to the back of the mailpiece, or on the front if space permits. ta. A. Signatur L» X ‘ w D Agent 5. U Address B. R éfiégmw% C. Date of Deliue <10mbr ‘ 1. ArticleAddressedto: Titmu‘lfl, Padmfiézs‘ gag? 132M five gé/ Mime Luff ’1W llEfilHlfll EHM lfllfllil llllllli\||fl\||llHi|| IEH 9590 9402 81 06 0209 8501 88 w- ‘ 2. Article Number (Transfer from service {abep [W H 1m 01893{mm 157337931 /D. winery; address di ea m Item 1? U Yes YES enter delivery a w: U No 3-39W 1:1 Piiofity Mail Express® D Adult Slgna u .D Registered Mair” U Adult Slgnature Restricted Delivery 'El R lstered Mail Restrk B Certified Mail® Dewery U Certified Mail Restricted Defivery D Return Recexptfor D Colract on Delivery Memhandlse D Collect on Delivery ReSUicted DelIvery U Signature Conrfl'matlm’ B Insured Mail U Signature Cunfu’matior D Insured Mall Restricted Delivery RESEfiCted Detivery {over $500) to. ~na- ... 1' a PS Form 3811, July 2015 PSN 7530-02-000-9053 Domeéfiéfié’mm Recei; p < USPS TRACKING# LWEHD EILFEIE Elflb DED‘i BED]; 35 United Statés Postal Service 'Ftrst-Ciass Mail Postage & Fees Paid USPS Permit No. G,-10 I . ° Senden'Ple’a‘se print your name, address. and ZIP+4® in this‘box" H7 WM I Ed ”5770’5-35 Km dam m §§th gmawmk “iEWEi‘iunsw : *gii .Ei i”; gill=li.;13;;z;li‘;ié‘séxlM3)
