Proof of Service PersonalCal. Super. - 6th Dist.January 27, 2021l I Clerk stamps date here when form is filed. CH-200 Proof of Personal SerVIce F I L F(D Person {eleking Protection C2) ® | {dc E wasa‘ FEB -1 2021 \ Name: Person From Whom Protection Is Sought Name: Vla’o/ MOMU . Notice to Server The server must: 0 Be 18 years 0f age or older. 0 Not be listed in items CD or® of Form CH-IOO. Fill in coun name and slree! address: Superior Court of California, County of Santa Clara 0 Give a copy 0f all documents checked in@ t0 the person in@. Street Address: 191 North First Street (You cannot scnd them by mail.) Then complete and sign this Mailing AddreSSI 191 North Flrst Street form and give or mail it to the person in G). 33" JOSE CA 951 1 13 Civil Divnsuon r'I/ ' h f ‘ H .PROOF OF FERSONAL SERVICE Court I s In case numberw en ormls led . Case Number: [gave the person 1n®a copy of the forms checked below: 4 )CH 0%:bm CH-109, Notice 0f Court Hearing m CH-l 10, Temporary Restraining Order m CH-IOO, Requextfnr Civil Hurus‘smem Restraining Orders m CH-l 20, Rexponse t0 Requestfor Civil Harassment Resrruining Orders (blank form) m CH-lZO-INFO, How Can l Respond In a Requextfur Civil Harassment Restraining Orders? D CH- l 30, 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 Pane Application for orders for Civil Harassment (CV-5014); I How Do | Turn In or Sell My Firearms? (CH-800-l F0); Local form FM-1 047 I personally gave poples 0f the documents checked above t0 the person m : a. On (date):(oblvw Y 2) b. Al(lirrlé’).' g'ys/ fl a.m. D p.m. c. Atlhis addresiy'l q é" (ml CitySM 95¢ State: CF Zip:“I ‘7.- Server's Information Name:(%. 3 O‘I.MZ Address: 45-6 Z Wfié'd" City: ELK 0'0“" V Telephone: .’ 343% ‘,\ g\%-g’(éZ (Ifyou are a registered process server): County of registration: Registration number: =rtz°r~r°9r>sr9= State: CJ‘ Zipyfir/Sg I declare under penalty of perjury under the laws of the State of California that the information above is true and correct. Date: ’2///2(1[ I / / b 7 Type or prim server's numr Srrwr m xix" hrrr / mm: comm: came. mownmwv Proof of Personal Service v CH-200, Page 1 o! 1 RevisedJ 1. 2014. Options! F cod. a cm pere. 5527‘s” (Civil Harassment Prevention)