Proof of Service MailCal. Super. - 6th Dist.February 22, 2021CH 250 PrOOf Of SerVice Of Response by Clerk stamps dare here when form is filed‘' Mail Q) Person Seeking Proteaif: F I L~ E l Name: nsnon w vmza APR 2 6 2021 I® Person From Wh m Prot ction ls Sought Your Name: , fi’m nY-hnfié \V ' ® Notice to Server The server must: o Be 18 years of age or older. o Live or be employed in the county where the mailing took place. 0 Not be listed in items G) or® ofForm CH-lOO. ' Mail a copy of all documents checked in® 10 the person in®. o Complete and sign this form and give it to the person in®. case Number: q PROOF OF SERVICE BY MAIL Z! CH 00E ® I am 18 years of age 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 of all documents checked below: Fill in court name and street address: Superior Court of California. County of Superior Court 0|le Dlvlslon 191 N. First St San Jose, 0A 95113 Fill in case number: a. Form CH- 1 20, Response Io Requestfor Civil Harassment Restraining Orders b. D Other (specifil): ® I placed copies of the documents ghecked above in a sealed envelope and mailed them as described below: a. Mailed to (name): BY \ S(‘l“0l erfmmf . b. To this address: Hag“ FUQU m_n‘djfl fl Cit)“ 4%” JQLCg State: 6L Zip:ML. C- On (date): Z 'Z [a- Z J Mailed from: City: 34h JOJK State: (Zfi @ Server’s Information Name:_ ?flé 222 A&[fifl Address: 7 l 3. Llrk §‘r Cityzgfin/ §D€( State: r,“ Zip: 75/] Z. Telephone: L108 q 2.x 2% LP ‘ (Ifyou are a registeredprocess server): County of registration: Registration number: I declare under penalty of perjury under the laws of the State of California that the information above is true and correct. Date: .02 'atp ’ij ADer VI-Ila/on F wwA/é/n) I . ; . Type orprmr server s name Sewer to 51g" here Judicial Couna‘l of Califo'nia. www mans ca gov R" JanuthZmopWme Proof of Service of Response by Mail 0°“ °'°‘V“P’°¢°°“'°- 55275 (Civil Harassment Prevention) CH-250, Page 1 of1
