Proof of Service PersonalCal. Super. - 6th Dist.January 22, 2021\ ' Clerk stamps date here when form is filed. CH-ZOO Proof of Personal SerVIce ® ® Person Seeking Protection | L ENzameM\ Eg't‘rmofl z Person From Whom Protection ls Sought MAY 1 1 2021 Name: \iolqmdq («arcuq Notice to Server K I The server must: Kg?“ 2'52 ° BC l 8 years Ofage 0r Older. gé/S‘L/ K‘g/R Fill in coun nfime and street address: (j ngi Hll/ \4/ 0 Not be listed in items CD or® Superior ¢ourt of California, County of ofForm CH-IOO. Santa Clara ° Give a copy ofall documents checked in® to the person in®. :91 :1 Fitfgq (You cannot send them by mail.) Then complete and sign this an osc‘ 3 13 form and give or mail it to the person in PROOF OF PERSONAL SERVICE Case Number: I gave the person in®a copy of the forms checked below: 1\ c ++ 004 89.1 a. E CH-109, Notice ofCourt Hearing E CH-l 10, Temporary Restraining Order E CH- 1 00, Requesrfiv Civil Harassment Restraining Orders E CH-IZO, Response (0 Requestfor Civil Harassnwn! Restraining Orders (blank form) E CH-lZO-INFO, How Can l Respond t0 a Requcslfor Civil Harassment Restraining Orders? D CH-l30, Civil Harassment Restraining OrderAfIcr Hearing E CH-800, ProofofFirearms Turned In, Sold, orStorcd (blank form) E Other (Specifi'): Decl. CV-SOI4 and Civil Case Cover Sheet CM-OIO ?rqorwopop‘ I personally gave copies of the documents checked above to the person in®: a. On (date): H IIQ'$} b. At(ti"1€)i I3 :00 D 1mg p.m. c. At this address: QB ?\nVé 6+ City Sa n 1”rose j I Sme-_¢_ zip;m Server's Information fa Name.film /MW/C% fifi {U Address: flfl/[_, dbd gflaflé/ Cit: Sf 4’ State: O4, 2i: 9é~/ \Sx Tel:phone: yayr- fsy.’ 972V --- P___j (Ifyou are a registered process server): County 0f registration: Registration number: I declare under penalty of perjury under the laws of the State of Califomia that the information above is true and correct. Date: W Z/é/ ”gm 05%) Type orprim sen er s naM¢ Sc n er gig" hen Judlaal Counul of Calufomla. wwwcouns ca gov ' CH-Zoo, Pa e 1 Of 1 Rem, My 1. 2m opuma, Fem Proof of Personal Servnce 9 C066 0‘ CW“ ”0686m- § 527 5 (Civil Harassment Prevention)
