Proof of Service PersonalCal. Super. - 6th Dist.January 28, 2021I Clerk stamps date here when form is filed. CH-ZOO Proof of Personal Servuce - ((952% é j. .- (D Person S eking Protection Name mm Br? \ MAR 26 2021® Person From Whom Protection Is Sought ' ClName mmrkm u \\m mg9UMb “Sm. “@900“ _ _F*@’Notice to Se‘nTer‘4 B v DEPUTY__ 95:.gm \, The server must: SOB!” A . Be 18 years 0f age 0r Olden {/\‘§y,‘\ Fill In coun‘ name and street address}, ° Not be listed in items® 0r© [EB /:% Superior Court of California, County ofofForm CH-lOO. Santa Clara 191 N. First St.° Give a copy ofall documents checked 1n® to the person in®./J S J0 CA 951 13an se,(You cannot send them by mail.) Then complete and sign this form and give or mail it t0 the person in PROOF OF PERSONAL SERVICE Case Number:® Igave the person in®a copy 0fthe forms checked below: Q\ C H OO qR Z/qCH- 1 09, Notice ofCourt Hearing CH-l 10, Temporary Restraining Order CH-IOO, Requestfor Civil Harassment Restraining Orders CH-IZO, Response t0 Requestfor Civil Harassment Restraining Orders (blank form) CH-l 20-INFO, How Can I Respond Io a Requestfor Civil Harassment Restraining 0rdérs? CH- I 30, Civil Harassmenr Restraining Order After Hearing CH-SOO, ProofofFireanns Turned In, Sold, or Stored (blank form) Other (specify): Decl. CV-5014 and Civil Case Cover Sheet CM-OlO / CH "' ‘ \ b ® omlflll’OWWL¥0Ipersonallybcrave copies of the documents checked above to the person in® Commow C”V a. On (dare):m[efl%b. At(time). q 55 a..m®m p..m c. At this address: 05% WWmCW5---A#3 City‘a‘rm To‘fis-Q \J State LE“- ZipigéflL ® Server's Inform Ion Namerfl)W10? rDNCKm \VKCV‘ Address: ?)EMFfl @MOQL C+U City axwh F \CAWQ State: W- Zip: qgogl Telephone: wW (Ifyou are a registered process server): ?qu Hm 9.0 .crw HEDEHEHE County 0f registration: Registration number: Ideclare under penalty of perjury under the laws 0f the State 0f California that the information above is true and correct. Date: ward“ fig, 2/" gvajé/ Type orp’i’" serve” 3 Mme Server'ro sign here JdY‘ICOU'IICaI’f', , “ ' C. Rigid My": 501dlgflfygiamnfim°ag°v Proof of Personal SerVIce H 200, Page 1 of1 WW‘CM'F’MW'552’6 (Civil Harassment Prevention)
