On May 06, 2019 a Proof of Service was filed involving a dispute between Anthony L Perez, Successor-In-Interest To The Estate Of Jordan Lee Perez, Perez, Anthony L, Perez, Sandra L, Sandra L Perez, Successor-In-Interest To The Estate Of Jordan Lee Perez, and Abongwa M.D., Chenue, Barcega M.D., Besh R, Bravo M.D, Thomas P, Brown M.D., Lance A, Collins M.D., Chelsea L, Does 2-200, Inclusive, Fteeh M.D., Gamil, Kheradpour M.D., Albert, Kim M.D., Tommy Y, Klooster M.D., Marquelle J, Kong, P.A., Yuthana, Li M.D., Natasha Y, Loma Linda University Children'S Hospital A Nonprofit Corporation, Loma Linda University Health A Nonprofit Corporation, Loma Linda University Medical Center A Nonprofit Corporation, Mehta M.D., Khyati P, Peterson M.D., Sarah C, Pichon M.D., Pilar D, Richter, David, Sadanand M.D., Venkatraman, Suterwala M.D., Batul, Thorp M.D., Andrea W, Zimmerman M.D, Kimberly R, Zouros M.D., Alexander, for Complaint for Medical Malpractice in the District Court of San Bernardino County.
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POS010 FOR COUR7 f SE OI Y ATTORNEY OR PARTY WITHOUT ATTORNEY Mame S6a e Barn xnber sndaddress Anthony L Perez Sandra L Perez 14322 Arae St Hesperia CA 92344 rE or e r o 951 515 33 71 FAX NO Optiona k t na no ss am alpslp@live com r 3 C arrorzr v roR aame In Pio P8r GUL 1C 7 e R r s NF SUPERIOR COURT OF CALIFORNIA COUNTY OF San Bernardino S E 247 West 3rd St G 1 n n cnoo ss 247 West 3rd St rrY ANo zP cooE San Bernardino 92415 Z Bw cH w e San Bernardino District Civil Division P vNT FF Ermor Ea Perez CASE NUMBER CIVDS 1913814 DEFENDANTIRESPONDENT LOIT11 L1TlC C1 UIllVeTSl M0 1C81 C6riteI @t al Ref No or Fde Na PROOF OF SERVICE OF SUMMONS Separate p oof of seroice is required for each party senred 1 At the time of service I was at least 18 years of age and not a party to this adion 2 I served copies of a Q sumrrmns b Q compiaint c 0 Attemative Dispute Resotution ADR package d Q Civil Case Cover Sheet served in romplex cases only e qoss complaint t ott er specify documents Declaration of Anthony L Perez Sandra L Perez pursuant to CCP337 32 3 a Party serv l speci y name of party as shown on documents served Loma Linda University Medieal Center b Person other than the party in item 3a served on behaff of an entity or as an authorized agent and not a person uncier item 5b a whorn subsMuted service was made specifY name and relationship fo the party narned in item 3a Kent A Hansen agent for service for LLIJMC and their employees 4 Address where the party was served 24894 Tulip Ave Loma Linda CA 92354 5 I served the party check proper box a bY P o 1 Qersonauy d ivered the dc cuments listed in item 2 to the party or person authorized to ive service of process for the par y 1 on date 08 14 2019 2 at re eJ 3 30 p m b 1 left the documents listed in item 2 with or by substituted service On date at time in the presence of name and tiUe or relationship to person ind ated in item 3 1 Q business a person at least 18 years of age apparentiy in charge at the office or usua place of business of the person to be served I infortned him w her afthe general nature af the pa rs 2 home a competent member of the t sehold at least 18 years af age at the dv lling house or usual place of abode of the party I informed him or her ofthe general nature of the papers 3 Q physical address unknown a person at least 18 years of age apparenUy in charge at the usual mailing address ofthe person to be served other than a United States Pastat Service post office box I informed him or her of the general nature of the pap ers 4 Q 1 tl ereafter mailed by first dass postage epaid copies of the dax merds to the person to be served at the place where the copies were left Code Civ Proc 415 20 1 mailed the documants on date from city or a dedaration of mailing is attached 5 0 I attach a declaration of diligence stating actions taken first to attempt personal senrice Pags of2 Code of Cinl Procedure 417 10 F aidam d aa cou or caxran a PROOF OF SERVICE OF SUMMONS Poso o ia wary zoo PLAINTIFFlPETITIONER peieZ CNDS 1913814 EFEN ANTrRESPONOENr Loma Linda University Medical Center et al 5 c 0 by il and adcrwwledgment of receipt of service i mai ed the documents i wted in iterr 2 to the pariy to the address shown in item 4 by first iass maii postage prepaid 1 on date 2 from city 3 with two copies of the Notice and Acknowledgment ofReceipt and a postage paid retum envebpe addressed to me Attach completed Notice and Acknowledgement of Reeeipt Code Civ Proc 415 30 4 to an address outside Califomia arith retum receipt requested Code Civ Proc 415 4U d by other nneans specify means of senrice and authorizing c de section Additional page describing service is attaehed 6 The Notice to the Person Served on the summons was oompleted as fotlows a as an iruiividual defendant b as the person sued under the fictitious name of specify c as occupant d On behatf of specifjr under the following Code of Civil Procedure section 416 10 corporatKm 415 95 business aganization form unknown 416 20 defunct corporation 0 416 60 minor 0 416 30 joint stock company association 416 70 ward or conservatee Cl 416 40 association or partnership 416 9Q authorized persan C 416 5U public entity 0 415 46 occupanf other 7 Person wtw served papers a Name Kelsey Tiller b Address 14322 Arae St Hesperia CA 92344 c Telephone number 720 400 3634 d The fee for service was 0 e I am 1 0 not a registered Califomia process senrer 2 0 exempt from registration under Business and Professions Code section 22350 b 3 0 a registered Califomia process server t emPbYee independent contr c or a Registration No iii County 8 0 1 declare under penalty of perjury under the laws of the State of Califomia that the foregoing is true and correct or 9 1 am a California sheriff ar marsfial and i cerlify that the fo egoing is true and c rrect Date August 19 2019 Kelsey Tiller NAME OF PERSON WHO SERVED PAPERS SHERIFF OR MARSHAL SIGNATURE J Z r2 PROOF OF SERVICE OF SUMMONS