ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, state number, and address):

FOR COURT USE ONLY

SUM-300

FAX NO.:

TELEPHONE NO.:

ATTORNEY FOR (Name):

NAME OF COURT:

STREET ADDRESS:

MAILING ADDRESS:

CITY AND ZIP CODE:

BRANCH NAME:

PLAINTIFF/ PETITIONER:

DEFENDANT/ RESPONDENT:

DECLARATION OF LOST SUMMONS 
AFTER SERVICE

CASE NUMBER:

1. 

At the time of service, I was at least eighteen (18) years of age and not a party to this action.

2. 

On (date):

,  I served a copy of a Summons together with (specify documents):

on defendant/cross-defendant/respondent in this proceeding, in the manner described below.

3. 

Name of party served and title, if any:

4. 

Person with whom a copy of the Summons was left, and title or relationship to party served:

5. 

Mailing date and type of mail:

6. 

Address, city, and state (when required, indicate whether address is home or business):

7. 

Manner of service:
a.
b.

Personal service.  By personally delivering copies to person served. (Code Civ. Proc., § 415.1 0.)
Substituted service on a corporation or unincorporated association (including partnership or public entity).  By 
leaving, during usual office hours, copies in the office of the person served, with the person who apparently was in charge 
and thereafter mailing (by first-class mail, postage prepaid) copies to the person served at the place where the copies 
were left.  (Code Civ. Proc., § 415.20(a).
Place of mailing (specify):

Substituted service on natural person, minor, or incompetent. By leaving copies at the dwelling house, usual place of 
abode, or usual place of business of the person served with or in the presence of a competent member of the household 
or  a  person  apparently  in  charge  of  the  office  or  place  of  business,  at  least  18  years  of  age,  who  was  informed  of  the 
general nature of the papers, and thereafter mailing (by first-class mail, postage prepaid) copies to the person served at 
the place where the copies were left. (Code Civ. Proc., § 415.20(b).) Attached is a separate declaration or affidavit stating 
acts relied on to establish reasonable diligence in first attempting personal service.
Place of mailing (specify):

Mail  and  acknowledgment  of  service.    By  mailing  (by  first-class  mail,  postage  prepaid)  copies  to  the  person  served, 
together with two copies of the notice and acknowledgment provided for in Code of Civil Procedure section 415.30(b) and 
a return envelope, postage prepaid, addressed to the sender.  (Code Civ. Proc., § 415.30.) Attached is a completed copy 
of the notice and acknowledgment of receipt mailed to the sender.  Place of mailing (specify):

c.

d.

Form Adopted for Mandatory Use 
Judicial Council of California 
SUM-300 [Rev. January 1, 2007]

DECLARATION OF LOST SUMMONS 
AFTER SERVICE

Page 1 of 2

www.courtinfo.ca.gov

e.

a.
b.
c.

PLAINTIFF/PETITIONER:

DEFENDANT/RESPONDENT:

CASE NUMBER:

SUM-300

Certified or registered mail service. By mailing to an address outside California (by registered or certified mail with 
return receipt requested) copies to the person served.  (Code Civ. Proc., § 415.40.) Attached is a signed return receipt or 
other evidence of actual delivery to the person served.  
Place of mailing (specify):

f.

Other.  Specify other manner of service and authorizing code sections:

Continued on Attachment 7f.

8.

The following notice appeared on the copy of the Summons served (Code Civ. Proc., § 412.30, 415.10, or 474):

You are served as an individual defendant.  
You are served as (or on behalf of) the person sued under the fictitious name of (specify):
You are served on behalf of (specify):
under: 

(5)

(1)
(2)
(3)
(4)

Code Civ. Proc., § 416.10 (corporation)
Code Civ. Proc., § 416.20 (defunct corporation) 
Code Civ. Proc., § 416.40 (association/partnership) 
By personal delivery on (date):

(6)
(7)

Code Civ. Proc., § 416.60 (minor) 
Code Civ. Proc., § 416.70 (conservatee) 
Code Civ. Proc., § 416.90 (individual)

9.

This declaration is returned in lieu of the original Summons.

10.

Declarant's current address and telephone number are as follows: 
a.  Address:

b. Telephone number:

Date:

I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

(TYPE OR PRINT NAME)

(SIGNATURE OF DECLARANT)

SUM-300 [Rev. January 1, 2007]

DECLARATION OF LOST SUMMONS 
AFTER SERVICE

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