Proof of Service PersonalCal. Super. - 6th Dist.January 20, 2021® Person Seeking Protection _ Clerk sta e here when form is flied Proof of Personal Servuce Person From Whom Protection ls Sought Name: DMISW HDn-‘CZ- a Co Notice to Server ?%qu Name; Mercedts ‘Mairema J "Fébgez £080?/ . ( a F " ”‘90The server must. {$33 gp ‘96° Be 18 years 0f age 0r Older- r/\_‘3p, D Fiilin court name and street addres‘; y 0 N01 be listed in items® or© \ /\‘“ éfif [I Superior Court of California, County of 0f Form CH-lOO. Santa Clara - Give a copy or an documents checked m® to the person in®. Street Address: 191 North First Street (You cannot send them by mail.) Then complete and sign this Mai'ing Addr9553 191 North FIFS‘ Street form and give 0r mail it t0 the person in (“D sa“ Josel CA 951113 Civil Division PROOF OF PERSONAL SERVICE CCU” {INS In C259 number When {Orm IS med. Case Number: QlCHOOfiX/Q' I gave the person in®a copy 0f the forms Checked below: a. m CH-109, Notice 0f Court Hearing b. m CH-llO, TemporatyRestraining Order m CH-lOO, Requesrfor Civil Harassment Restraining Orders m CH-l 20, Responxe t0 Requeslfor Civil Harassmen! Resrraining Orders (blank fonn) m CH-l 20-INFO, How Can I Rca‘pond t0 a Requestfor Civil Harassmem Restraining Orders? D CH-l30, Civi! Harassment Restraining Order After Hearing CH-SOO, ProofofFirem'ms Turned In, Sold, 0r Stored (blank form) m Other (specify): Decl. Re: Notice Upon Ex Parte Application for orders for Civil Harassment (CV-5014); How Do | Turn In or Sell My Firearms? (CH--800- [ F0); Local form FM-1047 I personally gave copi s of the documents checked above to the person in a. 0n(dme).- OZ [ZII/ZOZI b. Aurime): 7 25 D am Kpm c. Atlhisaddress: Iffag Mrdfiflp/ A54hid JAM M, 6/4 @572 l City: San (7-056 State: (/4 U Zip: Server s Informatlo Namafpbéfl'afi "MCLVQWQ' Address:5 KOS- OAM /o ¥+€ Cf, _ City: SQ A JOS€ State: ()4- Zip: 6‘37 Z 3 Telephone: kL/O$)F qg/ - ng g, ' (Ifyou are a registered process sewer): rqorfiQP-P County of registration: Registration number: [declare under penalty of perjury under the laws 0f the State 0f California that the information above is true and correct. Date: O} /2:}-/"2,02( W/t/ JW/er m signMllere / JTme or prim sen'er‘s name- Judicial CouncilolCaJifumia. W.couns.ca.gov PrOOf Of Personal sewice/ CH'200! Page 1 0f 1 Revisedduly 1.2014,0pu‘onaJ Form . . Code of Civil Procedure, 552716 (CIVII Harassment Prevention)