Pos 040 Form – Fill Out and Use This PDF

Fourth box, left side: Check the method of service that was used. You should check only one method of service and should show proof of only one method on the form. If you served a party by several methods, use a separate form to show each method of service.

Certain documents must be personally served. For example, an order to show cause and temporary restraining order generally must be served by personal delivery. You must determine whether a document must be personally delivered or can be served by mail or another method.

The law may require that documents be served in a particular manner (such as by personal delivery) for certain purposes. Service by fax generally requires the prior agreement of the parties.

First box, left side: In this box print the name, address, and telephone number of the person for whom you served the documents.

Second box, left side: Print the name of the county in which the legal action is filed and the court's address in this box. The address for the court should be the same as the address on the documents that you served.

Third box, left side: Print the names of the plaintiff/petitioner and defendant/respondent in this box. Use the same names as are on the documents that you served.

Second box, right side: Print the case number in this box. The case number should be the same as the case number on the documents that you served.

Third box, right side: State the judge and department assigned to the case, if known.

First box, top of form, right side: Leave this box blank for the court's use.

You are stating that you are over the age of 18.

Print your home or business address.

If service was by fax service, print the fax number from which service was made.

List each document that you served. If you need more space, check the box in item 4, complete the Attachment to Proof of Service-Civil (Documents Served) (form POS-040(D)), and attach it to form POS-040.

Provide the names, addresses, and other applicable information about the persons served. If more than one person was served, check the box on item 5, complete the Attachment to Proof of Service-Civil (Persons Served) (form POS-040(P)), and attach it to form POS-040.

(Complete if service was by personal service, mail, overnight delivery, or messenger service.) Business or residential address where person was served:

(Complete if service was by fax.) Fax number where person was served:

Check the box before the method of service that was used, and provide any additional information that is required.

By personal service. I personally delivered the documents to the persons at the addresses listed in item 5. (1) For a party represented by an attorney, delivery was made (a) to the attorney personally; or (b) by leaving the documents at the attorney's office, in an envelope or package clearly labeled to identify the attorney being served, with a receptionist or an individual in charge of the office; or (c) if there was no person in the office with whom the notice or papers could be left, by leaving them in a conspicuous place in the office between the hours of nine in the morning and five in the evening. (2) For a party, delivery was made to the party or by leaving the documents at the party's residence with some person not younger than 18 years of age between the hours of eight in the morning and eight in the evening.

By United States mail. I enclosed the documents in a sealed envelope or package addressed to the persons at the addresses in item 5 and (specify one):

deposited the sealed envelope with the United States Postal Service, with the postage fully prepaid.

The envelope or package was placed in the mail at (city and state):

By overnight delivery. I enclosed the documents in an envelope or package provided by an overnight delivery carrier and addressed to the persons at the addresses in item 5.

I placed the envelope or package for collection and overnight delivery at an office or a regularly utilized drop box of the overnight delivery carrier.

By messenger service. I served the documents by placing them in an envelope or package addressed to the persons at the addresses listed in item 5 and providing them to a professional messenger service for service.

A declaration by the messenger must accompany this Proof of Service or be contained in the Declaration of Messenger.

By fax transmission. Based on an agreement of the parties to accept service by fax transmission, I faxed the documents to the persons at the fax numbers listed in item 5.

No error was reported by the fax machine that I used.

A copy of the record of the fax transmission, which I printed out, is attached.

If item 6d is checked, the declaration must be completed or a separate declaration from a messenger must be attached.

I personally delivered the envelope or package received from the declarant to the persons at the addresses listed in item 5.

I am over 18 years of age and not a party to the legal proceeding.

You must sign and date the proof of service form.

By signing, you are stating under penalty of perjury that the information that you have provided on form POS-040 is true and correct.

This proof of service form should not be used to show proof of service of a summons and complaint. For that purpose, use Proof of Service of Summons (form POS-010). Also, this proof of service form should not be used to show proof of electronic service. For that purpose, use Proof of Electronic Service (form POS-050).