UD COMPLAINT

SAMPLE
Use t he samples t o help
you complet e t he packet
of blank f or ms.
 CM-010
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): FOR COURT USE ONLY

YOUR NAME
YOUR ADDRESS
YOUR PHONE#
TELEPHONE NO.: FAX NO.:
I N PRO PER
ATTORNEY FOR (Name):

SUPERIOR COURT OF CALIFORNIA, COUNTY OF Sant a Clara

STREET ADDRESS: CHECK WI TH STAFF
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME: Civil Division
CASE NAME: Your Last Name VS Tenant ' s Last Name

CIVIL CASE COVER SHEET Complex Case Designation CASE NUMBER:

 Unlimited X Limited
 Leave Blank
 Counter  Joinder
JUDGE: Leave Blank
(Amount (Amount
demanded demanded is Filed with first appearance by defendant
exceeds $25,000) $25,000 or less) (Cal. Rules of Court, rule 3.402) DEPT.: Leave Blank
Items 1-6 below must be completed (see instructions on page 2).
1. Check one box below for the case type that best describes this case:
Auto Tort Contract Provisionally Complex Civil Litigation
 Auto (22)  Breach of contract/warranty (06) (Cal. Rules of Court, rules 3.400-3.403)
 Uninsured motorist (46)  Rule 3.740 collections (09)  Antitrust/Trade regulation (03)
Other PI/PD/WD (Personal Injury/Property  Other collections (09)  Construction defect (10)
Damage/Wrongful Death) Tort  Insurance coverage (18)  Mass tort (40)

 Asbestos (04)  Other contract (37)  Securities litigation (28)

 Product liability (24) Real Property  Environmental/Toxic tort (30)

 Medical malpractice (45)  Eminent domain/Inverse  Insurance coverage claims arising from the
above listed provisionally complex case
 Other PI/PD/WD (23) condemnation (14)
types (41)
Non-PI/PD/WD (Other) Tort  Wrongful eviction (33)
 Business tort/unfair business practice (07)  Other real property (26) Enforcement of Judgment

 Civil rights (08) Unlawful Detainer  Enforcement of judgment (20)

 Defamation (13)  Commercial (31) Miscellaneous Civil Complaint
 Fraud (16) 
X Residential (32)  RICO (27)
 Intellectual property (19)  Drugs (38)  Other complaint (not specified above) (42)
 Professional negligence (25) Judicial Review Miscellaneous Civil Petition
 Other non-PI/PD/WD tort (35)  Asset forfeiture (05)  Partnership and corporate governance (21)
Employment  Petition re: arbitration award (11)  Other petition (not specified above) (43)
 Wrongful termination (36)  Writ of mandate (02)
 Other employment (15)  Other judicial review (39)
2. This case  is X is not complex under rule 3.400 of the California Rules of Court. If the case is complex, mark the
factors requiring exceptional judicial management:
a.  Large number of separately represented parties d.  Large number of witnesses
b.  Extensive motion practice raising difficult or novel e.  Coordination with related actions pending in one or more courts
issues that will be time-consuming to resolve in other counties, states, or countries, or in a federal court
c.  Substantial amount of documentary evidence f.  Substantial postjudgment judicial supervision
3. Remedies sought (check all that apply): a.  X monetary b.  X nonmonetary; declaratory or injunctive relief c.  punitive
4. Number of causes of action (specify): ONE
5. This case  is  X is not a class action suit. CHECK WHI CH BOX(ES) APPLY
6. If there are any known related cases, file and serve a notice of related case. (You may use form CM-015.)

Date:Today' s Dat e
Print Your Name(TYPE OR PRINT NAME) Sign Your(SIGNATURE
Name OF PARTY OR ATTORNEY FOR PARTY)

NOTICE

Plaintiff must file this cover sheet with the first paper filed in the action or proceeding (except small claims cases or cases filed
under the Probate Code, Family Code, or Welfare and Institutions Code). (Cal. Rules of Court, rule 3.220.) Failure to file may result
in sanctions.

File this cover sheet in addition to any cover sheet required by local court rule.

If this case is complex under rule 3.400 et seq. of the California Rules of Court, you must serve a copy of this cover sheet on all
other parties to the action or proceeding.

Unless this is a collections case under rule 3.740 or a complex case, this cover sheet will be used for statistical purposes only.
Page 1 of 2

Form Adopted for Mandatory Use

Judicial Council of California
CIVIL CASE COVER SHEET Cal. Rules of Court, rules 2.30, 3.220, 3.400-3.403, 3.740;
Cal. Standards of Judicial Administration, std. 3.10
CM-010 [Rev. July 1, 2007] www.courtinfo.ca.gov
SHC/FLF SAMPLE
 CM-010
INSTRUCTIONS ON HOW TO COMPLETE THE COVER SHEET
To Plaintiffs and Others Filing First Papers. If you are filing a first paper (for example, a complaint) in a civil case, you must
complete and file, along with your first paper, the Civil Case Cover Sheet contained on page 1. This information will be used to compile
statistics about the types and numbers of cases filed. You must complete items 1 through 6 on the sheet. In item 1, you must check
one box for the case type that best describes the case. If the case fits both a general and a more specific type of case listed in item 1,
check the more specific one. If the case has multiple causes of action, check the box that best indicates the primary cause of action.
To assist you in completing the sheet, examples of the cases that belong under each case type in item 1 are provided below. A cover
sheet must be filed only with your initial paper. Failure to file a cover sheet with the first paper filed in a civil case may subject a party,
its counsel, or both to sanctions under rules 2.30 and 3.220 of the California Rules of Court.
To Parties in Rule 3.740 Collections Cases. A "collections case" under rule 3.740 is defined as an action for recovery of money
owed in a sum stated to be certain that is not more than $25,000, exclusive of interest and attorney's fees, arising from a transaction in
which property, services, or money was acquired on credit. A collections case does not include an action seeking the following: (1) tort
damages, (2) punitive damages, (3) recovery of real property, (4) recovery of personal property, or (5) a prejudgment writ of
attachment. The identification of a case as a rule 3.740 collections case on this form means that it will be exempt from the general
time-for-service requirements and case management rules, unless a defendant files a responsive pleading. A rule 3.740 collections
case will be subject to the requirements for service and obtaining a judgment in rule 3.740.
To Parties in Complex Cases. In complex cases only, parties must also use the Civil Case Cover Sheet to designate whether the
case is complex. If a plaintiff believes the case is complex under rule 3.400 of the California Rules of Court, this must be indicated by
completing the appropriate boxes in items 1 and 2. If a plaintiff designates a case as complex, the cover sheet must be served with the
complaint on all parties to the action. A defendant may file and serve no later than the time of its first appearance a joinder in the
plaintiff's designation, a counter-designation that the case is not complex, or, if the plaintiff has made no designation, a designation that
the case is complex.
CASE TYPES AND EXAMPLES
Auto Tort Contract
Breach of Contract/Warranty (06) Provisionally Complex Civil Litigation (Cal.
Auto (22)-Personal Injury/Property Rules of Court Rules 3.400-3.403)
Damage/Wrongful Death Breach of Rental/Lease
Contract (not unlawful detainer Antitrust/Trade Regulation (03)
Uninsured Motorist (46) (if the Construction Defect (10)
case involves an uninsured or wrongful eviction)
Contract/Warranty Breach-Seller Claims Involving Mass Tort (40)
motorist claim subject to Securities Litigation (28)
arbitration, check this item Plaintiff (not fraud or negligence)
Negligent Breach of Contract/ Environmental/Toxic Tort (30)
instead of Auto) Insurance Coverage Claims
Warranty
Other PI/PD/WD (Personal Injury/ Other Breach of Contract/Warranty (arising from provisionally complex
Property Damage/Wrongful Death) Collections (e.g., money owed, open case type listed above) (41)
Tort book accounts) (09) Enforcement of Judgment
Asbestos (04) Collection Case-Seller Plaintiff Enforcement of Judgment (20)
Asbestos Property Damage Other Promissory Note/Collections Abstract of Judgment (Out of
Asbestos Personal Injury/ Case County)
Wrongful Death Insurance Coverage (not provisionally Confession of Judgment (non-
Product Liability (not asbestos or complex) (18) domestic relations)
toxic/environmental) (24) Auto Subrogation Sister State Judgment
Medical Malpractice (45) Other Coverage Administrative Agency Award
Medical Malpractice- Other Contract (37) (not unpaid taxes)
Physicians & Surgeons Contractual Fraud Petition/Certification of Entry of
Other Professional Health Care Other Contract Dispute Judgment on Unpaid Taxes
Malpractice Real Property Other Enforcement of Judgment
Other PI/PD/WD (23) Eminent Domain/Inverse Case
Premises Liability (e.g., slip Condemnation (14) Miscellaneous Civil Complaint
and fall) Wrongful Eviction (33) RICO (27)
Intentional Bodily Injury/PD/WD Other Real Property (e.g., quiet title) (26) Other Complaint (not specified
(e.g., assault, vandalism) Writ of Possession of Real Property above) (42)
Intentional Infliction of Mortgage Foreclosure Declaratory Relief Only
Emotional Distress Quiet Title Injunctive Relief Only (non-
Negligent Infliction of Other Real Property (not eminent harassment)
Emotional Distress domain, landlord/tenant, or Mechanics Lien
Other PI/PD/WD foreclosure) Other Commercial Complaint
Non-PI/PD/WD (Other) Tort Case (non-tort/non-complex)
Unlawful Detainer Other Civil Complaint
Business Tort/Unfair Business Commercial (31)
Practice (07) (non-tort/non-complex)
Residential (32)
Civil Rights (e.g., discrimination, Drugs (38) (if the case involves illegal Miscellaneous Civil Petition
false arrest) (not civil drugs, check this item; otherwise, Partnership and Corporate
harassment) (08) report as Commercial or Residential) Governance (21)
Defamation (e.g., slander, libel) Other Petition (not specified
(13) Judicial Review above) (43)
Fraud (16) Asset Forfeiture (05) Civil Harassment
Intellectual Property (19) Petition Re: Arbitration Award (11) Workplace Violence
Professional Negligence (25) Writ of Mandate (02) Elder/Dependent Adult
Legal Malpractice Writ-Administrative Mandamus Abuse
Writ-Mandamus on Limited Court Election Contest
Other Professional Malpractice Case Matter
(not medical or legal) Petition for Name Change
Writ-Other Limited Court Case Petition for Relief from Late
Other Non-PI/PD/WD Tort (35) Review Claim
Employment Other Judicial Review (39) Other Civil Petition
Wrongful Termination (36) Review of Health Officer Order
Other Employment (15) Notice of Appeal-Labor
Commissioner Appeals
CM-010 [Rev. July 1, 2007] CIVIL CASE COVER SHEET Page 2 of 2
 TENANT' S NAME(S)

YOUR NAME

LEAVE BLANK
SUPERI OR COURT OF CALI FORNI A
CHECK WI TH STAFF

YOUR NAME YOUR PHONE #

YOUR ADDRESS
X

VERN
YOUR NAME
TENANT' S NAME(S) LEAVE BLANK
 UD-100
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): FOR COURT USE ONLY

YOUR NAME
YOUR ADDRESS

TELEPHONE NO.: YOUR PHONE# FAX NO.(Optional):

E-MAIL ADDRESS (Optional):

ATTORNEY FOR (Name): I N PRO PER

SUPERIOR COURT OF CALIFORNIA, COUNTY OF Sant a Clara
STREET ADDRESS: CHECK WI TH STAFF
MAILING ADDRESS:

CITY AND ZIP CODE:

BRANCH NAME: Civil Division

PLAINTIFF: Your Name

DEFENDANT:Tenant ' s Name(s)

DOES 1 TO
CASE NUMBER:

X COMPLAINT
COMPLAINT - UNLAWFUL DETAINER*
Leave Blank


AMENDED COMPLAINT (Amendment Number) :
Jurisdiction (check all that apply) :
X ACTION IS A LIMITED CIVIL CASE

ARE YOU ASKI NG FOR
Amount demanded
does not exceed $10,000

exceeds $10,000 but does not exceed $25,000 MORE OR LESS THAN $ 10, 000?

ACTION IS AN UNLIMITED CIVIL CASE (amount demanded exceeds $25,000)

ACTION IS RECLASSIFIED by this amended complaint or cross-complaint (check all that apply) :

from unlawful detainer to general unlimited civil (possession not in issue)
from limited to unlimited

from unlawful detainer to general limited civil (possession not in issue)
from unlimited to limited
1. PLAINTIFF (name each) : Your Name

alleges causes of action against DEFENDANT (name each) :

Tenant ' s Name(s)
2. a. Plaintiff is (1) X an individual over the age of 18 years.

(4)
a partnership.
(2)
a public agency. (5)
a corporation.
(3)
other (specify) :
b.
Plaintiff has complied with the fictitious business name laws and is doing business under the fictitious name of (specify) :

3. Defendant named above is in possession of the premises located at (street address, apt. no., city, zip code, and county) :
ADDRESS OF RENTAL PROPERTY

Are you t he owner or manager

4. Plaintiff's interest in the premises is
as owner
other (specify) :
5. The true names and capacities of defendants sued as Does are unknown to plaintiff. of t he propert y?
defendant (name each) : List
6. a. On or about (date) :Dat e Tenant (s) signed lease Tenant (s) Name(s) you cont ract ed wit h

Check t he boxes

t o describe

t he rent al
(1) agreed to rent the premises as a month-to-month tenancy other tenancy (specify) :



(2) agreed to pay rent of $ payable monthly other (specify frequency) :

agreement


b. This
(# 6a. and 6b. )


written


(3) agreed to pay rent on the
oral
first of the month
agreement was made with
other day (specify) :

(1)
plaintiff. (3)
plaintiff's predecessor in interest.

(2)
plaintiff's agent. (4)
other (specify) :

*NOTE: Do not use this form for evictions after sale (Code Civ. Proc., § 1161a). Page 1 of 3
Form Approved for Optional Use COMPLAINT - UNLAWFUL DETAINER Civil Code, § 1940 et seq.
I f t here was a writ t en rent al agreement at t ach a copy of it t o t his complaint
Judicial Council of California
UD-100 [Rev. July 1, 2005]
Code of Civil Procedure §§ 425.12, 1166
www.courtinfo.ca.gov
 PLAINTIFF (Name) : Your Name CASE NUMBER:
Leave Blank
DEFENDANT (Name) :Tenant ' s Name(s)

6. c.
The defendants not named in item 6a are

(1)
subtenants. Are t here any ot her people living in t he rent al unit t hat
(2)
assignees.
are not on t he rent al agreement ? Who are t hey?
(3)
other (specify) :
d.
The agreement was later changed as follows (specify) :
I f t here was a change t o t he lease, check t he box
and describe t he change (EX. Rent went up or down)
e.
A copy of the written agreement, including any addenda or attachments that form the basis of this complaint, is attached
I f you
and labeled have
Exhibit a copy of
1. (Required t he rent al
for residential agreement
property, unless mark
item 6ftis
his box and
checked. Seeat t achCiv.
Code a Proc.,
copy and label it "Exhibit 1"
§ 1166.)

f. (For residential property) A copy of the written agreement is not attached because (specify reason) :
(1)
the written agreement is not in the possession of the landlord or the landlord's employees or agents.
I f you don' t have a copy of t he r ent al agr eement , why? Mar k box "f " and check "(1)" or "(2)"
(2)
this action is solely for nonpayment of rent (Code Civ. Proc., § 1161(2)).
X
7.
a. Defendant (name each) : Tenant ' s Name(s)

T enant (s) name(s) you gave not ice t o. Descr ibe how you gave not ice t o t he t enant (s). Check t he box t hat applies below

was served the following notice on the same date and in the same manner:
(1)
3-day notice to pay rent or quit (4)
3-day notice to perform covenants or quit
(2)
30-day notice to quit (5)
3-day notice to quit
(3)
60-day notice to quit (6)
Other (specify) :
b. (1) On (date) : DATE NOTI CE ENDED the period stated in the notice expired at the end of the day.
(2) Defendants failed to comply with the requirements of the notice by that date.
c. All facts stated in the notice are true.
d.
The notice M arincluded
k "e" if it applies
an election t o you.
of forfeiture.
x
e.
A copy of the notice is attached and labeled Exhibit 2. (Required for residential property. See Code Civ. Proc.,
§ 1166.) At t ach a copy of t he not ice
f.
One or more defendants were served (1) with a different notice, (2) on a different date, or (3) in a different
manner, as stated in Attachment 8c. (Check item 8c and attach a statement providing the information required
by items 7a-e and 8 for each defendant.)
8. a. X The notice in item 7a was served on the defendant named in item 7a as follows:


(1)
by personally handing a copy to defendant on (date) : DESCRI BE HOW THE NOTI CE
(2)
by leaving a copy with (name or description) : WAS GIVEN TO THE TENANT. ,
a person of suitable age and discretion, on (date) : at defendant's

residence
business AND mailing a copy to defendant at defendant's place of residence on
(date) : because defendant cannot be found at defendant's residence or usual
place of business.
(3)
by posting a copy on the premises on (date) :
AND giving a copy to a
person found residing at the premises AND mailing a copy to defendant at the premises on
(date) :
(a)
because defendant's residence and usual place of business cannot be ascertained OR
(b)
because no person of suitable age or discretion can be found there.
(4)
(Not for 3-day notice; see Civil Code, § 1946 before using) by sending a copy by certified or registered
mail addressed to defendant on (date) :
(5)
(Not for residential tenancies; see Civil Code, § 1953 before using) in the manner specified in a written
commercial lease between the parties.
b.
(Name)CHECK
: HERE AND FI LL OUT I F THI S APPLI ES TO YOU
was served on behalf of all defendants who signed a joint written rental agreement.
c.
Information about service of notice on the defendants alleged in item 7f is stated in Attachment 8c.
X
d.
Proof of service of the notice in item 7a is attached and labeled Exhibit 3.

ATTACH PROOF OF SERVI CE OF THE NOTI CE

UD-100 [Rev. July 1, 2005] COMPLAINT - UNLAWFUL DETAINER Page 2 of 3

SHC/FLF SAMPLE
 PLAINTIFF (Name) : Your Name CASE NUMBER:
Leave Blank
DEFENDANT (Name) : Tenant ' s Name(s)

9.
Plaintiff demands possession from each defendant because of expiration of a fixed-term lease.
10.
At the time the 3-day notice to pay rent or quit was served, the amount of rent due was $
x

11.
The fair rental value of the premises is $ MONTHLY RENT

x
per day.
DI VI DED BY 30 FI LL I N I F YOU GAVE A 3- DAY NOTI CE
12.
Defendant's continued possession is malicious, and plaintiff is entitled to statutory damages under Code of Civil
Procedure section 1174(b). (State specific facts supporting a claim up to $600 in Attachment 12.)

13.
A written agreement between the parties provides for attorney fees.

14.
Defendant's tenancy is subject to the local rent control or eviction control ordinance of (city or county, title of ordinance,
and date of passage) :

Plaintiff has met all applicable requirements of the ordinances.

15.
Other allegations are stated in Attachment 15.
DATE AFTER RENT 3- DAY
16. Plaintiff accepts the jurisdictional limit, if any, of the court.
NOTI CE COVERS
17. PLAINTIFF REQUESTS
a. possession of the premises. f. X damages at the rate stated in item 11 from


b. costs incurred in this proceeding: (date) : FI LL I N for each day that
c.
X past-due rent of $AMOUNT ON 3- DAY NOTI CE
defendants remain in possession through entry of judgment.
d.
reasonable attorney fees. g.
statutory damages up to $600 for the conduct alleged in item 12.
X forfeiture of the agreement.
e.
h.
other (specify) :
X Number of pages attached (specify) :
18.
FI LL I N

UNLAWFUL DETAINER ASSISTANT (Bus. & Prof. Code, §§ 6400-6415)

19. (Complete in all cases.) An unlawful detainer assistant
X did not
did for compensation give advice or assistance
with this form. (If plaintiff has received any help or advice for pay from an unlawful detainer assistant, state:)

a. Assistant's name: c. Telephone No.:

b. Street address, city, and zip code: d. County of registration:
e. Registration No.:
f. Expires on (date) :

Date: TODAY' S DATE

PRI NT YOUR NAME HERE ' SI GN YOUR NAME HERE

(TYPE OR PRINT NAME) (SIGNATURE OF PLAINTIFF OR ATTORNEY)

VERIFICATION

(Use a different verification form if the verification is by an attorney or for a corporation or partnership.)

I am the plaintiff in this proceeding and have read this complaint. I declare under penalty of perjury under the laws of the State of
California that the foregoing is true and correct.

Date: TODAY' S DATE

PRI NT YOUR NAME HERE ' SI GN YOUR NAME HERE
(TYPE OR PRINT NAME) (SIGNATURE OF PLAINTIFF)

UD-100 [Rev. July 1, 2005] COMPLAINT - UNLAWFUL DETAINER Page 3 of 3

SHC/FLF SAMPLE
 POS-010
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address) : FOR COURT USE ONLY

YOUR NAME
YOUR ADDRESS

TELEPHONE NO.: YOUR PHONE# FAX NO. (Optional):

E-MAIL ADDRESS (Optional):

ATTORNEY FOR (Name): I N PRO PER

SUPERIOR COURT OF CALIFORNIA, COUNTY OF Sant a Clara
STREET ADDRESS: CHECK WI TH STAFF
MAILING ADDRESS:

CITY AND ZIP CODE:

BRANCH NAME: Civil Division

PLAINTIFF/PETITIONER: Your Name CASE NUMBER:
Leave Blank
DEFENDANT/RESPONDENT: Tenant ' s Name(s)

Ref. No. or File No.:

PROOF OF SERVICE OF SUMMONS

(Separate proof of service is required for each party served.)

1. At the time of service I was at least 18 years of age and not a party to this action.
2. I served copies of:
a.
X summons
b.
X complaint
c.
Alternative Dispute Resolution (ADR) package
d.
Civil Case Cover Sheet (served in complex cases only)
e.
cross-complaint
f.
other (specify documents) :

3. a. Party served (specify name of party as shown on documents served) :

TENANT' S NAME
(YOU MUST DO A PROOF OF SERVI CE FOR EACH TENANT. )
b.
Person (other than the party in item 3a) served on behalf of an entity or as an authorized agent (and not a person
under item 5b on whom substituted service was made) (specify name and relationship to the party named in item 3a):

4. Address where the party was served: SERVER FI LLS I N ADDRESS WHERE TENANT WAS
HANDED THE FORMS
5. I served the party (check proper box)
a.
X by personal service. I 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) : DATE SERVER SERVED (2) at (time) : TI ME SERVER SERVED
b.
by substituted service. On (date) : at (time) : I left the documents listed in item 2 with or
in the presence of (name and title or relationship to person indicated in item 3) :

(1)
(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. I informed him or her of the general nature of the papers.
(2)
(home) a competent member of the household (at least 18 years of age) at the dwelling house or usual
place of abode of the party. I informed him or her of the general nature of the papers.
(3)
(physical address unknown) a person at least 18 years of age apparently in charge at the usual mailing
address of the person to be served, other than a United States Postal Service post office box. I informed
him or her of the general nature of the papers.
(4)
I thereafter mailed (by first-class, postage prepaid) copies of the documents to the person to be served
at the place where the copies were left (Code Civ. Proc., § 415.20). I mailed the documents on
(date) : from (city): or
a declaration of mailing is attached.
(5)
I attach a declaration of diligence stating actions taken first to attempt personal service.
Page 1 of 2
Form Adopted for Mandatory Use
Judicial Council of California
PROOF OF SERVICE OF SUMMONS Code of Civil Procedure, § 417.10
POS-010 [Rev. January 1, 2007]

SHC/FLF SAMPLE
 PLAINTIFF/PETITIONER: Your Name CASE NUMBER:
Leave Blank
DEFENDANT/RESPONDENT: Tenant ' s Name(s)

5. c.
by mail and acknowledgment of receipt of service. I 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) :
(3)
with two copies of the Notice and Acknowledgment of Receipt and a postage-paid return envelope addressed
to me. (Attach completed Notice and Acknowledgment of Receipt.) (Code Civ. Proc., § 415.30.)
(4)
to an address outside California with return receipt requested. (Code Civ. Proc., § 415.40.)
d.
by other means (specify means of service and authorizing code section) :

Additional page describing service is attached.

6. The "Notice to the Person Served" (on the summons) was completed as follows:
a.
X as an individual defendant.
b.
as the person sued under the fictitious name of (specify) :
c.
as occupant.
d.
On behalf of (specify) :
under the following Code of Civil Procedure section:

416.10 (corporation)
415.95 (business organization, form unknown)

416.20 (defunct corporation)
416.60 (minor)

416.30 (joint stock company/association)
416.70 (ward or conservatee)

416.40 (association or partnership)
416.90 (authorized person)

416.50 (public entity)
415.46 (occupant)

other:
7. Person who served papers
a. Name: NAME OF PERSON WHO GAVE THE PAPERS TO THE TENANT (NOT YOU!)
b. Address: ADDRESS OF PERSON WHO GAVE THE PAPERS TO THE TENANT (NOT YOU!)
c. Telephone number: PHONE NUMBER OF THE SERVER.
d. The fee for service was: $
e. I am: X
(1)
not a registered California process server.
(2)
exempt from registration under Business and Professions Code section 22350(b).
(3)
registered California process server:
(i)
owner
employee
independent contractor.
(ii) Registration No.:
(iii) County:

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


or
9.
I am a California sheriff or marshal and I certify that the foregoing is true and correct.

Date: DATE SI GNED

PRI NT NAME OF PERSON WHO SERVED ' SI GNATURE OF PERSON WHO SERVED
(NAME OF PERSON WHO SERVED PAPERS/SHERIFF OR MARSHAL) (SIGNATURE)

POS-010 [Rev. January 1, 2007] PROOF OF SERVICE OF SUMMONS Page 2 of 2

SHC/ FLF SAMPLE