Proof of Service PersonalCal. Super. - 6th Dist.February 16, 2021. Clerk stamps date here when form is filed. CH-200 Proof of Personal Servuce ® Person Seeking Protection F I L EName: QQme VQ\ AQK JUL 2® Person From Whom Protection Is Sought q 2021 fName 3 1‘ i (m \m \ l X 6 n mm, ° “930823, cm, ® Notice to Sewer K A BY - DEPUTY#9 ”- \ The server must: c T; )’ Go 0 Be 18 ears of ace or older. ‘5 /A - -y a /\ y,‘\ fl K Fill In courf name and street address: o Not be listed in items® or© ( )' p fffi ’1 r / I Superior Court of California, County of ofForm CH-100. Is» ’ x 27 Santa Clara 191 N. First St. 0 Give a copy of all documents checked in® to the person in®. San Jose CA 951 13 (You cannot send them by mail.) Then complete and sign this form and give or mail it to the person in PROOF OF PERSONAL SERVICE Case Number:® I gave the person in®a copy of the forms checked below: Z I 0H ooq 8bqE CH-109, Notice ofCourt Hearing E CH-l 10, Temporary Restraining Order E CH- 1 00, Requestfbr Civil Harassment Restraining Orders E CH-120, Response t0 Requestfor Civil Harassment Restraining Orders (blank form) E CH-lZO-INFO, How Can I Respond t0 a Requestfbr Civil Harassment Restraining Orders? D CH-l 30, Civil Harassment Restraining Order After Hearing E CH-SOO, ProofofFirearms Turned In, Sold, 0r Stored (blank form) E Other (specify): Decl. CV-5014 and Civil Case Cover Sheet CM-OlO I [/71 ///é Frqcrnsvgpvs» © I personally gave copies of the documents checked above to the person in®. a. On (date): 7 ‘ 2 g’ Zl b. At (time) q-__00 E/am D pm c. Atthis address: I50 $2 vH dd: no] EH74 ‘HQL fl Tat I City: ern 3056 \J State: 6/4‘ Zip. Tyl/D ® Server's Information Name. 5 GT VOYWQh Address I50 W Heddxna Shed CltY- 5a.“ Q03? State: CA Zip: qSI/O Telephone: HDK~ 29q~ 230 Q (Ifyou are a registered process server): County of registration: Registration number: Ideclare under penalty of perjury under the laws of the State of California that the information above is true and correct. nae. v/zg'ZL ’fim awacu #xym Type or print server 's name Server to sign here $i€32333$$7§3fimfiamfim”a 9°" Proof of Personal Service CH'2°°’ P39“ °” 9°“ °‘ CW" ”mmm- 5 527 6 (Civil Harassment Prevention)
