Proof of Service

Cal. Form APP-109

California Superior Local Rules

Judicial Council of California, www.courts.ca.gov Rev. January 1, 2017, Optional Form Proof of Service (Appellate Division) APP-109 Proof of Service (Appellate Division) Clerk stamps date here when form is filed.

You fill in the name and street address of the court that issued the decision that is being challenged in this case: Superior Court of California, County of You fill in the number and name of the trial court case in which the decision being challenged was issued: Trial Court Case Number: Trial Court Case Name: You fill in the appellate division case number (if you know it): Appellate Division Case Number: Instructions This form is only for providing proof that a document has been served (delivered) in a proceeding in the superior court appellate division.

If you are serving a document electronically, please use Proof of Electronic Service (Appellate Division) (form APP-109E).

The person who serves (delivers) a document in this case and who fills out this form: Must be at least 18 years old Must NOT be a party in this case Before you fill out this form, read What Is Proof of Service? (form APP-109-INFO) to understand your responsibilities. 1 At the time I served the documents listed in 4 , I was at least 18 years old. 2 I am not a party in the case identified in the box on the right side of this page. 3 My home business address is: Street City State Zip I mailed or personally delivered the following document, as indicated below (check or fill in the name of the document you are serving and check and complete either a or b).

Notice of Appeal/Cross Appeal (Limited Civil Case) Notice Designating Record on Appeal (Limited Civil Case) Proposed Statement on Appeal ( Limited Civil Case Misdemeanor Infraction) Appellant’s Opening Brief Respondent’s Brief Appellant’s Reply Brief Abandonment of Appeal (Limited Civil Case) Petition for Writ (Misdemeanor, Infraction, or Limited Civil Case) Other (write in the name of the document): a. Service by Mail

(1) I put one copy of the document identified in an envelope addressed to each person listed in (2), sealed the envelope, and put first-class postage on the envelope. APP-109 For your protection and privacy, please press the Clear This Form button after you have printed the form. Rev. January 1, 2017 Proof of Service (Appellate Division) Appellate Division Case Name: Appellate Division Case Number:

(2) The envelope or envelopes were addressed as follows: (

a) Name of person served: Address on envelope: Street City State Zip (b) (Name of person served: Address on envelope: Street City State Zip Check here if you mailed copies of the document identified in to more people. Attach a separate page listing the names and addresses on each additional envelope you mailed. Write “APP-109, Item 4a” on the top of the page.

(3) I mailed the envelope or envelopes on (date): from (city): (state): by depositing the envelope or envelopes (check one): (

a) With the U.S. Postal Service or (

b) At an office or business mail drop where I know the mail is picked up every day and deposited with the U.S. Postal Service. b. Service by Personal Delivery I personally gave one copy of the document identified in to each of the following people: (1) (

a) Name of person served: (b) (Address where you gave the documents to this person: Street City State Zip (

c) Date when you gave the documents to this person: (

d) Time when you gave the documents to this person: (2) (

a) Name of person served: (b) (Address where you gave the documents to this person: Street City State Zip (

c) Date when you gave the documents to this person: (

d) Time when you gave the documents to this person: Check here if you gave copies of the document identified in to more people. Attach a separate page listing the names of each of these people, the address where you gave each of them the document, and the date and time you gave them the document. Write “APP-109, Item 4b” on the top of the page. 5 I declare under penalty of perjury under California state law that the information above is true and correct. Date: Type or print server’s name Server signs here after serving APP-109

Document details

Collection	California Superior Local Rules
Citation	Cal. Form APP-109
Type	court_rule
Language	en
Format	pdf
Source	CA_LOCAL
Identifier	d10f20d87a924a97889b0e588efd80f0e6a4ecb1

Source file is stored in the law ingest library (pdf).