Proof of Service MailCal. Super. - 6th Dist.February 23, 2021Mail ® Person Seeking Protection Name: \kR0mm\LW ® Person From Whom Prot » Your-Name: \A\\ &\_\Q)\_ _ O\}®\X\ ® Notice to Serve The server must: Be 18 years 0f age or older. Live or be employed in the county where the mailing took place. Not be listed in items G) or© ofForm CH-lOO. Mail a copy ofall documents checked in© ‘tq the person in® . Complete and sign this form and give it, to the person in®. PROOF OF SERVICE BY MAIL ® 1am 18 years of age or older and not a party to this progeeding. I live or am employed in the county where the mailing took place. I mailed the person in© a copy of all documents checked below: .Fonn CI-I-IQO, Response t0 Requestfor Civil Harassment Restraining Orders b. D Other (Specifiz): Proof of Service of Response by tion ls Soug l lerk stamps dale here when form is filed. . (1“, ' Fifi in court name and street address: Superior Court of California, County of Superior Court Civil Division 191 N. First Si San Joan, CA 95113 Fm in case number: Case Numb r: 1m 00%386 k ® Iplaced copies 0f the documents checked above in a §ealed enveIOpe and mailed them as described below: | a. Mailedto (name): \‘L\:\ QQQCX b. To this address: 7%? PbQ\QM\% U City: S&“TERQ, \xgmm \NY ~ State:C.&5pmU / c. onmmexoéy 15;; 0;! Mailed from: City: Sm 365594 - State; ® Server’s Informationf Name: Je$ét C‘b M. AU) iw Address: 515 \3fi \‘Zef m City;\SF»\\ 3056 Telephone:( Lb?) loq ‘1 \4Q (Hyatt are a registeredprocess sewer): County ofregistration: Mikalo .J State: CA Zip: 015-] 3g Registration number: Ideclare under penalty ofpeljury under the laws of the State of California that the information above is true and correct. . DatefJ;_%_J_-k\ \S 2‘03“] SM 0; M‘AVI "k/ Type 0rprint server 's name Owcmfim SM‘ r0 sign kw ‘ Judicial Council 01Cafilomia; wwmmm:oa.gov Rev. Januaty 1. 2012. Optimal Form Code of Civfl Proceduxe. § 527.5 Proof of Service of Response by Mail (Civil Harassment Prevention) CH-ZSO, Page1 of1