Santa Clara — sample form

Source: https://santaclara.courts.ca.gov/system/files/sampledeclarationofpersonalservice_0.pdf

Sample Form ATTORNEY OR PARTY WITHOUT ATTORNEY (Name and Address) FOR COURT USE ONLY TELEPHONE NO:

ATTORNEY FOR (Name) NAME OF COURT:

STREET ADDRESS:

MAILING ADDRESS:

CITY AND ZIP CODE:

BRANCH NAME: PETITIONER/PLAINTIFF:

RESPONDENT/DEFENDANT: DECLARATION OF PERSONAL SERVICE CASE NUMBER

__________________________________________________declares: I am and was on the

dates herein mentioned over the age of eighteen years and not a party to this action; I served the (insert

name of paper(s) served): _________________________________________________________________________

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_________________________________________________________________________in this action by

personally delivering to and leaving with the following person (s). In the County of _________________.

State of California, on the date set opposite their respective names, a true copy thereof, to-wit:

Name: _____________________________________________________ Date served: ________________

Address: ___________________________________________________Time served: ________________

Name: _____________________________________________________ Date served: ________________

Address: ___________________________________________________ Time served: ________________

Name: _____________________________________________________ Date served: ________________

Address: ___________________________________________________ Time served: ________________

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

Executed on _____________________ at __________________________________________, California. (date) (place)

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Signature

DECLARATION OF PERSONAL SERVICE

Revised August, 2003