Proof of Service PersonalCal. Super. - 6th Dist.January 6, 2021CD ® ® _ Clerk stamps dare here when form isTi/ed. CH-200 Proof of Personal Servnce Person Seekin Protection I L E Y3 FM x 'm‘ Y M JAN112021 Person From Whom Protectqon ls Sought Cl I 0'm 3ml u Name: Name: §+L £42 LA VIA H $ a Notice to Server " Q?0 Be 18 years of age or older. The server must: h yes Fill in coun name and street address: r0 Not be listed in items® or® r f ,\ $ ’a I Superior Court of California, County off of Form CH-loo. ‘I": x Santa Clara ° Give a copy of all documents checked in@ to the person in®. Street Address: 191 North First Street (You cannot send them by mail.) Then complete and sign this Mailing AddfeSSI 191 North FlfSt Street form and give or mail it to the person in <1). sa" Jose! CA 951 1 13 Civil Division PROOF OF PERSONAL SERVICE CCU” ’Il/S in case number When form i5 flied. _ Case Number: I gave the person m®a copy of the forms checked below: Z\Q\-\Oo 0. 6 O 0 m CH-109. Notice ofCourt Hearing m CH-l 10, Temporary Restraining Order m CH-lOO, Requestfor Civil Harassment Restraining Orders m CH- l 20, Response to Requestfor Civil Harassment Restraining Orders (blank form) m CH-l 20-INFO, How Can I Respond to a Requestfor Civil Harassment Restraining Orders? D CH-l30, Civil Harassment Restraining Order After Hearing m CH-800, ProofofFirearms Turned In, Sold, 0r Stored (blank form) m Other (specify): Decl. Re: Notice Upon Ex Parte Application for orders for Civil Harassment (CV-5014); , How Do | Turn In or Sell My Firearms? (CH-8OQ-l F0); Local form FM-1047 I personally gave coples of the documents checked above t0 the person 1n : a. On (date): Q! ‘ a Q‘tfl\ b, At(time): q :qo D a.m. mm. c. At this address: blq QT? pd \Qufi Bf\l City: $ a r~ DOS x State: Qk Zip: qfi VB C. Server's gatormati Name: q, dala Address: 333.) L” a City24&% State: m Zip: (SI/é Telephone: ‘f $37314 (Ifyou are a registered process server): County of registration: Registration number: FrtznerP-ov.» I declare under penalty of perjury under the laws of the State of California that the information above is true and correct. Date: L/l/g a Type or prim server's name Seww Judia‘al Council oi Cailomia, m‘oouns.ca.gov PrOOf Of Personal serVice CH'ZOO, Page 1 Of 1 Revised July 1. 2014. Optional Form . . coca o: cavu Fromm. g 527.6 (Clvil Harassment Prevention)
