Proof of Service MailCal. Super. - 6th Dist.February 9, 2021CH 250 Probf of Service of Response by Cierk stamps dale here whenformismed. ‘_ - D Mall ® ® @ GD ® ® Person Seeking Protection Name talkmad QM; rn’ azi Person From Whom Protection Is Sought YourNameI K&Vl‘n Esklcman Notice to Server The server must: o Be 18 years of age or older. o Live 0r be employed in the county where the mailing took place. o Not be listed in items® or © of Form CH-IOO. o Mail a copy 0f all documents Checked in ® Io the person in @. o Complete and sign this form and give it to the person in® FIJI in court name and street address: ' Superior Court of California, County oi Superior 6mm civifl Division 191 N. First: Si San Jose, EA 951W Fill in case number: Case Number: PROOF 0F SERVICE BY MAIL Q l CH OOQ B SLO I am 18 years of age or older and not a party to this proceeding. I Iivc 0r am employed in [he county where the mailing took place. I mailed the person in® a copy 0f all documents checked below: a. Form CH- 120, Response to Requesrfar Civil Harassment Restraining Orders b. D Other (Specify): I placed copies 0f the documents checked above in a sealed envelope and mailed them as described below: a. Mailed to (name): fl kma a Am] Crx'fll-t b. T0 this address: Iggag Vlfla Dr. City: L03 fja'f'ofi State: (kg Zip: fl S O&i c. On (dare): "{ *1 -& 1 Mailed from: City: I Q5 ("flfifi Statmfl Server’s Information Name: jqnp/c/ 51! ézé/ Address: [é 37/5 (obj? Léhf City: L05 flgjto s State: (:fl Zip:fig}- Tclcphone: V&fi/ 33’s, 33 69 ([fyou arc a registered process server): County 0f registration: Registration number: I declare under penalty 0f perjury under the laws of the State of California that thc information above is true and correct. Date 7///;1 2) 542A E&Leke/ //fl% Type 0r print server 'sJaame .SW/é sign here Juulciawouncuorcmma. wmkunsca‘yov Proof of Service of Response by Mail cH-250, Page 1 on Rov. January 1.2012, Ophonal Form . . - coaeofcivupmceuure,§sz7.a (Cm! Harassment Prevention) FéFyFur'pféteEtibn'an'd'privatfy', fileaSE‘p‘ress Irfictear" Ihls Form button after you have printed the form. : [ Print this form l I Save this form ‘ f‘CTEEFifié765n-
