Proof of service by facsimile


STATE OF <state>, COUNTY OF <county>

At the time of facsimile transmission, I was <employed in/a resident of> the County of <county>, State of <state> over the age of eighteen (18) years and not a party to the within action; my <business/home> address is <insert your business or home address>.

I transmitted to <name of party> the following document(s): <title of document served>, pursuant to Rule <number of local rule>. The facsimile machine I used complied with Rule <number of local rule> and no error was reported by the machine. Pursuant to Rule <number of local rule>, I caused the machine to print a transmission record of the transmission, a copy of which is attached to this declaration.

Executed on <date this form was signed>, at <City, State>.

I declare under penalty of perjury under the laws of the State of <state> that the above is true and correct.

<name of person effecting service>

Download proof of service by facsimile in Word Format

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