APP-109 - Proof of Service (Appellate Division)

Summary

Proof of Service (Appellate Division)

Text

Form ID: APP-109
Title: Proof of Service (Appellate Division)
Effective Date: 2017-01-01
Mandatory Form: no
Info Page: https://selfhelp.courts.ca.gov/jcc-form/APP-109
Primary Download URL: https://www.courts.ca.gov/documents/app109.pdf
Alternate Download URLs: https://www.courts.ca.gov/documents/app109info.pdf
Form Detail Page:
Proof of Service (Appellate Division)
(APP-109)
Tells the court that you had legal papers in a case in the Superior Court Appellate Division delivered to (served on) the other party either by mail or in person.  Tells what papers were served and when they were served. For in person service, also says where the papers were served and who served them.
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Get instructions for form APP-109
Effective: January 1, 2017
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PDF Text:
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
4 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   4   in an envelope addressed to each person listed in (2), 
sealed the envelope, and put first-class postage on the envelope.
APP-109 Page 1 of 2

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   4  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   4  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   4  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 Page 2 of 2

Retrieval chunks

• #1

  Form ID: APP-109 Title: Proof of Service (Appellate Division) Effective Date: 2017-01-01 Mandatory Form: no Info Page: https://selfhelp.courts.ca.gov/jcc-form/APP-109 Primary Download URL: https://www.courts.ca.gov/documents/app109.pdf Alternate Download URLs: https://www.courts.ca.gov/documents/app109info.pdf …

• #2

  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…

• #3

  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 Page 2 of 2