NOTE If you are a party to the lawsuit for which this proof of service is being used, you cannot be the one who signs this form. Service must be effected by a non-party to a lawsuit.
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>