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

TELEPHONE NO.: FAX NO. (Optional): E-MAIL ADDRESS (Optional): ATTORNEY FOR (Name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF IMPERIAL 939 W. Main Street El Centro, CA 92243

PETITIONER:

RESPONDENT:

PROOF OF SERVICE FOR STEPPARENT ADOPTION CASE NUMBER:

1. I served the person cited (name): with the citation and petition as follows: a. by serving Person cited. b. Delivery at: home business 1. date: 2. time: 3. address:

2. Serviced:
Adoption Citation Petition to declare free Request for Adoption Request for Order

a. (Personal Service) by personally delivering copies
3. At the time of service I was at least 18 years of age and not a party to this action.
4. Fee for service: $
5. I am:
a. Not a registered California process server c. Exempt from registration
under Business and
Professions Code §22350(b)
b. A registered California process server d. California sheriff or marshal
6. Person Serving (name, address and telephone number):

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

Date:
(SIGNATURE OF PERSON SERVING)

Form Approved for Optional Use www.imperial.courts.ca.gov AD-05 (Adopted 01/01/12, Revised 01/01/13) PROOF OF SERVICE FOR STEPPARENT ADOPTION