Proof of Service PersonalCal. Super. - 6th Dist.February 9, 2021Clerk stamps dare here when form :‘s Med. .C 200 Proof of PersonalServicew ® Person Seeking Protection fl t Name: QM fl4b4r/ W/fl IQ ”42I Vx ® Person From Whom Protection Is Sought Name: fl P£)/jL EéOh/émnm @ Notice t6 Server The server must: ' Be 18 years 0f age 01‘ Oldef- Fitlin court name and streetaddress: 0 Not be listed in items® or@ 0f Form CH-IOO. Superior Court of California, County of _ , Santa Clara ° Give a copy 0f all documents checked in@ to the person in®. StreetAddressz 191 N0r1h First Street (You cannot send them by mail.) Then complete and sign this Mamng Address: 191 NOW? FIrSt Strefl form and give or mail it to the person in ®. 83" Jose: CA 951 1 13 Civil Division PROOF OF PERSONAL SERVICE CCU” {ms N7 0889 number When fofm IS filed. Case Number: ZwMo‘l (€35 K0® I gave the person in @21 copy 0f the forms checked below:m CH-109, Notice 0f Cour! Hearing m CH-l 10, Tempormy Restraining Order m CH-IOO, Requesr‘for Civil Harassmem Restraining Orders m CH-IZO, Response (0 Requestfor Civil Harassment Resrmining Orders (blank form) m CH-120-INFO, How Can I Respond r0 a Requestfor Civil Harassment Resrraining Orders? D CH-130, Civi! Harassment Restraining OrderAfi‘er Hearing CH-SOO, ProofofFirearms Turned In, Sold, 0r Stored (blank form) M Other (specify): Decl. Re: Notice Upon Ex Parte Application for orders for Civil Harassment (CV-5014); _ How Do l Turn In or Sell My Firearms? (CH-BOQ-INFO); Local form FM-1047® I personally gave coples of the documents checked above to the person 1n®2 a_ On (date); Eb‘} PH! ['20]?! b, Atflime): qty fl a.m."D pm. c. Atthis address: {$53! \fnfiu Ofiy‘fl, ' City: LOG, b’afi'fl‘s State: {1B Zip: 951223 ® Server's Information Namezfioaw Hallano Address: Iqsg Sbbmj-O Prwe pwaD City: Cflmnbpfl State: GR Zip: Q5009 Telephone: [HD%” 504 " 3 l bf} (Ifyou are a registered process sewer): ?rcrarher-OFP County of registration: Registration number: I declare under penalty of peljury under the laws of the State of California that the information above is true and COI‘I‘CCL Dam-Feb- W“! 902M (fl Type orprim server's name Server IL'J :ignlhere JudidaICouncilolCaflfornia. www.wunsravgov PrOOf Of Personal serVice CH-200, Page 1 0f1 R 'edJl 1.2014,0 uonaJForn . . . catesoucifl procedurfg 527.5 (CIVII Harassment Prevention)
