San Bernardino — 13-19890-360

Source: https://sanbernardino.courts.ca.gov/system/files/forms-filing/13-19890-360proofofservicenoticeofappealcodeenforcement.pdf

ATTORNEY OR PARTY WITHOUT (Name, State Bar Number, and address): COURT USE ONLY

Telephone No.: Fax No. (Optional):

ATTORNEY FOR (Name): Bar No.: SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN BERNARDINO

STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME

APPEAL OF (NAME):

RESPONDENTS: PROOF OF SERVICE CASE NUMBER: NOTICE OF APPEAL (CODE ENFORCEMENT)

1. At the time of service, I was at least 18 years old and not a party to this action. I served this Notice of Appeal (Code Enforcement) on the agency named below in the manner indicated below:

2. My residence or business address is as follows:

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3. Manner of Service (check and complete (a) or (b) below):

   (a) Personal Service. I personally delivered a true copy of the Notice of Appeal as follows:

   Name of Person document left with: Date of Service Time of Service:

   Address where delivered:

   (b) First Class Mail. I am employed in, or a resident of, the county where the notice was mailed. I deposited a
   true copy of the Notice of Appeal in the United States mail, enclosed in a sealed envelope with prepaid
   First Class postage as follows:

   Date of Mailing: Place of Mailing (City and State)

   Envelope addressed as follows:

   Name:

   Address:

I declare under penalty of perjury, under the laws of the State of California, that the foregoing is true and correct.

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Date

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Printed Name: Signature

PROOF OF SERVICE

NOTICE OF APPEAL (CODE ENFORCEMENT)

13-19890-360, Rev 04-2014