PROOF OF SERVICE
I am over the age of eighteen (18) years. I am employed by the
University of California, Davls Health System.
Check one of the two boxes below for either Personal- Delivery or
service by US MaiL:
,I
t I Service by Personal Dclivery. On (Date)
personally delivered the attached [Tit1e of Document] to the
following employee:
IInsert the
(s)
.
name of employee being issued the document
, I served the
t I Service by U.S. liail. On (Date)
placing
enclosed in
true
copy
a
attached [Tit1e of Document] by
sealed envelope with postage fuIly prepaid for delivery by the
U.S. Postal Service, addressed as follows:
(Type Name and Address)
I dectare under penalty otr perjury that the forqoing is
tnre and correct and that this declaratioa res executed on
(Date)
Print Name
Print Job Title
Attachments:
at Sacrancnto, Ca].ifornia.
Signature
a