Notice of lawsuit served to Jose Cisneros regarding a workers' compensation claim.

PROOF OF SERVICE SPECIAL NOTICE OF LAWSUIT 1):a. [x] Special Notice of Lawsuit [x] Order Joining Party Defendant [x] Application for Adjudication of Claim [ ] Medical Records b. on defendant (name): JOSE CISNEROS AN INDIVIDUAL AND DBA ALOSTA MOBILE HOME PARK c. Person served: () Party in 1(b) d. Address where the party was served: by mailing ( ) at home [x] Claim Form [x] Other (specify): ( ) Other (specify name and relationship to defendant): ( ) at business Amended Application For Adjudication & Addendum dated 11/11/19 Letter of Representation Demand For Records Preservation Letter Notice of Interpreter Request for Initial Comprehensive Report LC 4600 Letter Compliance With LC 4906(g) Venue Authorization Fee Disclosure Statement Consent to NonAttorney Representation Client Authorization Medical Authorization W9 WCIRB Results Pay Stub (1) date: (2) place: 2) Manner of service (check proper box) a. [ ] Personal service. By personally delivering copies (CCP 415.10) b. [ ] Substituted service on corporation, 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. [CCP 415.20(a)] c. [ ] Substituted service on natural person, minor, conservatee, or candidate. By leaving copies at the dwelling house, usual place of above, or usual place of business of the person served 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 on the general nature of the papers, and thereafter mailing on (date)_ from (city) _or ( ) declaration of mailing attached (by firstclass mail, postage prepaid) copies to the person served at the place where the copies were left. [CCP 415.20(b)] (Attach separate declaration or affidavit stating acts relied on to establish reasonable diligence in first attempting personal service.) d. [ ] Mail and acknowledgment service. By mailing (by first class mail or airmail, postage prepaid) copies to the person served, together with two copies of the form of notice and acknowledgment and a return envelope, postage prepaid, addressed to the sender. (CCP 415.30) (Attach completed acknowledgment of receipt.) e. [ ] Certified or registered mail service. By mailing to an address outside California (by firstclass mail, postage prepaid, requiring a return receipt) copies to the person served. (CCP 415.40) (Attach signed return receipt or other evidence of actual delivery to the person served.) f. [ ] Other (specify code section): g. [ ] Additional page describing service is attached. 3) The "Notice to the Person Served" (on the Notice) was completed as follows (CCP 412.30, 415.0 and 474): a. [x] as an individual defendant. JOSE CISNEROS AN INDIVIDUAL AND DBA ALOSTA MOBILE HOME PARK 4) At the time of service I was at least 18 years of age and not a party to this action. Address: 1773 W San Bernardino Rd, Ste B48, West Covina CA 91790 Telephone no.: (626) 6536626 a. [ ] Not a registered California process server. b. [ ]Exempt from registration under Bus. & Prof. Code 22350(b). c. [*] Registered California process server: (i) [ ] Owner [x] Employee [ (ii) Registration no.: 2022104908 (iii) County: Los Angeles d. [ ] California sheriff, marshal or constable. I declare under penalty of perjury under the laws of the State of California that the STATE OF CALIFORNIA DIVISION OF WORKERS' COMPENSATION WORKERS' COMPENSATION APPEALS BOARD APPLICATION FOR ADJUDICATION OF CLAIM Case Number ADJ11221313 SSN Amended Application *Venue Choice is based upon: O County of residence of employee (Labor Code section 5501.5(a)(1) or (d).) O County where injury occurred (Labor Code section 5501.5(a)(2) or (d).) County of principal place of business of employee's attorney (Labor Code section 5501.5(a)(3) or (d).) * Enter the zipcode for the venue choice designated above, and then tab to Hearing Location Field and choose the corresponding Hearing Location Code 91423 Injured Worker First Name* MANUEL MONTES MI Last Name* DE OCA Street Address 1 /PO Box* 3048 WASHINGTON AVE Street Address 2 /PO Box International Address City* State* EL MONTE CA Zip Code* (Numbers Only) 91731 VNO San Gabriel Valley Tribune Published: 3/2/26