Proof of Service PersonalCal. Super. - 6th Dist.January 7, 2021_ Clerk stamps dare here when form is fled. CH-ZOO Proof of Personal Servnce G) ® ® Person Seeking Protection Q I L EName: ’TQ a k k \an( Z V“ Person From Whom Protection Is Sought JAN 1 1 202' Name: 'LJQ \ gm S44v3 KY)“ ("m Notice to Server _\ "W The server must: $23 ! . Be 18 years 0f age or Older' /;‘z Fill in court name aly‘eet address: 0 Not be listed in items® or© r )' ,\ Superior Court of CMnia, County ofI 0f Form CH'IOO‘ ’ 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 First Street form and give or mail it to the person in ®. 53" J°Se- CA 951 1 13 Civil Division PROOF OF PERSONAL SERVICE Court fills in case number when form is filed. I th _ ® f h f h k d b l Case Number:rson o t e s c ec e w:gave epe 1n acopy orm e o ZlC-Hoaqgoz m CH-109, Notice 0f Court Hearing m CH-l 10, Temporary Restraining Order m CH-IOO, Requestfor Civil Harassment Restraining Orders m CII-IZO. Response to Request for Civil Harassment Restraining Orders (blank form) m CH-lZO-INFO, How Can I Respond t0 a Requestfor Civil Harassment Restraining Orders? D CH-130, Civil Harassment Reslraining Order After Hearing m CH-SOO, ProofofFirearms Turned In, Sold, or Stored (blank form) m Other (specify): Decl. Re: Notice Upon Ex Parte Application for orders for Civil Harassment (CV-5014); How Do I Turn In or Sell My Firearms? (CH-BOQolgox Local form FM-1047 P'UFWPP-PF‘P’ I personally gave copies of the documents checked above to the person m a. On (date): ‘5 i lob) Zo'u b. At(!ime)i 11“! 5 D a.m. Mm. c. At this address: (.1ng m1 \ Qea) (Q r-7 \ ' City: \ ‘N ngk State: O k Zip: 76 \3<¢ Server's Information Name: ‘ I 1. Address: $335 L3“: a City: State: flA Zip: ?II/g Telephone: 403437 - L849 (lfyou are a registered process server): County of registration: Registration number: I declare under penalty of perjury under thc laws of the State of California that the information above is true and correct. Date: 1/3/30 } I Type or prim sen'vr': name Serve ‘i n 4m councnovcamm m‘counmpov Proof of Personal Service CH-200. Page 1 0H sod _ 4, Opho' F (m 233'. otwRam. g 536° (Civil Harassment Prevention)