Santa Clara — CW-9043

Source: https://santaclara.courts.ca.gov/system/files/forms/cw-9043_rem.pdf

CW-9043 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar Number and Address) FOR COURT USE ONLY

TELEPHONE NO:

E-MAIL ADDRESS (Optional): ATTORNEY FOR (Name):

SUPERIOR COURT OF CALIFORNIA, COUNTY OF SANTA CLARA STREET ADDRESS: MAILING ADDRESS: 191 North First Street CITY AND ZIP CODE: San Jose, California 95113

BRANCH NAME:

CASE NUMBER:

PLAINTIFF/PETITIONER:

JUDICIAL OFFICER:

DEFENDANT/RESPONDENT:

CONSENT TO ELECTRONIC SERVICE OF COURT- DEPT:
ISSUED DOCUMENTS (CCP §1010.6(d))

1. The following self-represented party:

   a. Plaintiff/petitioner (name): b. Defendant/Respondent (name):

   c. Other (describe):

   Consents to electronic service by the Court of any documents issued by the Court that the Court is required to transmit, deliver or serve in the above-captioned action (CCP §1010.6(d)).

2. The electronic service address of the person identified in item 1 is (specify):

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Date:

(TYPE OR PRINT NAME) (SIGNATURE OF SELF-REPRESENTD PARTY)

CW-9043 New 2/3/25 CONSENT TO ELECTRONIC SERVICE OF COURT DOCUMENTS (CCP §1010.6(d))

CW-9043 CASE NAME: CASE NUMBER:

PROOF OF SERVICE

1. I am at least 18 years old and not a party to this action. My residence or business address and contact information are (specify):

   a. Home or Business Address: ____________________________________________________________

   b. Telephone Number: ___________________________________________________

   c. Email Address: ___________________________________________________

2. I served a copy of CONSENT TO ELECTRONIC SERVICE OF COURT-ISSUED DOCUMENTS (CCP §1010.6(d)) as follows:

□ By Mail □ By Personal Delivery □ By Email

a. Name of person served: ______________________________________________

b. Address at which person was served by mail, in person or via email::

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c. On (date): _________________________________

d. At (time): __________________________________

Information about additional parties served is described in an attachment.

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

Date:

(Print Name of Server) (Signature of server)

CW-9043 New 2/3/25 CONSENT TO ELECTRONIC SERVICE OF COURT DOCUMENTS (CCP §1010.6(d))