Proof of Service PersonalCal. Super. - 6th Dist.April 10, 2019: i , . wcrk stamps dare here when form is filed. Proof of Personal Service .a \I (3 Person%kin Protection - F I L E D Name: Jfléaflfl 74/42 APR 30 2019 Person From Whom Protection ls Sought Name: JBV‘Q-QQ-{fi/O Notice to Server f2) /*\ The sewer must: (gc? ?\2 v M_ OLAIVAR ,3 . ‘ 3 . . § /e\ ‘2' Be 18 3‘315 Of 3g“ 0' Oldel- ./)\\fil\ g? ’ (KKK FII/in couriname and streetaddress: . Not be IisLed in items ® or @ ‘ f \‘/\ I / j Superior Court of California, County of ofFonn CH-1 00. r". //@\@m ‘7 Sama Clara Civil Division 19] N. First St. San Jose, CA 951 13 ' Give a copy ofall documents Checked in @ to the person in®. (You cannot send them by mail.) Then complete and sign this form and give 01' mail it t0 the person in (D. PROOF OF PERSONAL SERVICE COLIN fills in case number when form is filed Case Number: I gave the person i11@)a copy OfIhe forms checked below: ‘ q 0H 006675 a. E CH-109,N01‘iceQfCourrHearing b. CH-HO, Tempon'njvResrmimng Order C. CH- 100. Reqlre.s‘ffl)l‘ Civil Hz’l/‘(Lsxx'nlern Rex!ruininz Ordurv d0 E CH-IZO, Rexponse m Reug/uestfbr Civil Hamsmmzr Rem (lining 0rd rx (bl ank fOIm) e. E] CH- lEO-INFO, How Can [Respond Io c7 Requcsrfiu C iw‘l Hamssnnn/ Resn‘aining Orders? Cl CH- 130, C’ivi/ Harm'snmzr Re'm‘u/ning Order Afmr HLL'z'irfng g E] CH-SO O Pmc‘nf'of'FircunnS Turned In S'o/d, m- S'mrczfl blank form) h. g Othel rspcufi) Cixil Cmel Shes: Declm 111011 111 8111313011 of E_\ Pane Apphmtion 101 O1de1s ‘ I personally gave copies ofthe documents checked above to the person 111 @r a. On (dare); Q g; {’2 i; {,7 b. At (time): X 00 D ammgpm. c. At this address: 1’50 Eas*- “Deana, Aug, Q0? £- Z\\ Cit}, “\o Mam \\‘\\\ State: g g Zip: q 503$- Server's lnfornqation Name: :ON #fflgANE/‘j Address: [30 f S lrflflA ST Ciw- M3004 p, Q State: (fl Z113: qyéé / Telephone: (é $0 2 éé ?A/Z ’70 q I1]; 011 a] e a regime) dpl m 9.1.? seI 1 er). Counrv 01‘1‘egist1-ation: Registration number: ldeclme u11de1 penah} 01 pe1 11m 111 1de1 the 13115 ofthe State o1 Califmnia th it Ihe 1111011115111011 abme 1s 11116 and COHBCI. Dare: §4//2§// q § {- ‘///.rCF----"' I,J/ I Type (II 1.1mm Venn c 11111111 51:11-11»- I1'1_\Ig17 hard t Proof 0f Personal Service CH'zoo’ Page 1 ‘3” (Civil Harassment Prevention)
