Name Name
Signature Signature
Date Date
Proof of Service
PURPOSE OF PROOF OF SERVICE
Use this form to confirm that you’ve given copies of any forms/documents you are filing with the Rent
Board to all opposing parties. This is called “service.” You can serve documents in three ways: in person
(hand delivery), by first-class mail, or by email. If you are filing and serving by email, you do not need to
complete this form. Just copy the opposing parties on the email and include the petition number or
property address in the email.
TO BE COMPLETED BY THE PERSON SERVING THE DOCUMENTS
I live in County (Berkeley is in Alameda County) and was at least 18 years old when I
delivered the following documents (for example, Tenant Petition for Rent Decrease, Schedule C, Housing
Code Enforcement Report, and email correspondence):
Date when the documents were delivered or mailed
I delivered the documents in the following way (Check the appropriate box):
I delivered the documents in person to the following individuals:
Name Name
Name Name
I mailed the documents by first-class mail to the following addresses:
Print name and address as shown on the envelope
Name Address
Name Address
Name Address
Name Address
I declare under penalty of perjury under the laws of the State of California that the above is true and
correct.
Name Date of Signing
Signature (must be handwritten, not typed)