Proof of Service MailCal. Super. - 6th Dist.January 28, 2021PI’OOf Of se rVice Of Response by Clerk stamps date here when form is filed. M ail Person Seeking Protection EName: ma H'Ck/By 1441 F I L Person From Whom Protection ls Sought MAR - 4 2021 Your Name: [fla/Ig’tly va/ayém/Zf" of the Court C3) Notice to Server Bys fiamdm The server must: o Be 18 years 0f age or older. o Live 0r be employed in the county where the mailing took place. 0 Not be listed in itcms® or© ofFonn CH-IOO. ° Mail a copy ofall documents checked in® to the person i116). ‘o Complete and sign this form and give it to the person in®. Fill in court name and street address: Superior Court of California. County of Fill in case number: Case Number: u LR 00 Ote “I PROOF OF SERVICE BY MAIL ® I am l8 years ofage or older and not a party to this proceeding. I live or am employed in the county where the mailing took place. I mailed the person in G) a copy ofall documents checked below: a. Form CH-l 20, Response t0 Requestfor Civil Harassment Restraining Orders b. D Other (specifi'): © I placed copies 0f the documents checked above in a sealed envelope and mailed them as described below: a. Mailed to (name): ma”en” \J “IGSCQW/‘z/ b. To this address: 10 sq wmhl YO L&(MA fl P \w 5 . . J Cxty: 5A R’EOSL State: .Cfl Zip: 45’ '1 C. On (date): 3 'é’ Ls Mailed from: City: £4ij$ State: L“ ® Server’sWn Name: V ‘ ?\C‘m\a>\L)/’ Addressijbo t WWML’M’ City: WWXfiH/Kauf0x State: 674‘ zap; 95 OS/ Telephone: (Ifyou are a regislered process server): County of registration: Registration number: I declare under penalty of petjury under the laws of thc State of California that the information above is true and correct. om;mmkfl } . l . \- Type 0r prmt sen'er s name Sen'er IoSW §?fl3fiffiz’f‘gptzaamfwm9°” Proof of Service of Response by Mail CH'25°' P39“ °” Code ovcwn procooma. 55276 (Civil Harassment Prevention)
