Proof of Service PersonalCal. Super. - 6th Dist.March 4, 20210r POS-020 ATTORNEY OR PARTY WITHOUT ATTORNEY (Nam, Stale Bar number, end address): FOR COURT USE ONLY Sandra Rivera Medina 131 3 Michigan Avenue Alviso CA 95002 TELEPHONE N0; 559-265.3720 FAX No. (OpImaJ): EMNL ADDRESS (Optiona/J: I E L EATTORNEY FOR (Name): ' SUPERIOR COURT 0F CALIFORNIA, COUNTY OF Santa Clara MAR 1STREEI ADDRESS: 2 202] 191 North First Street MNUNG ADDRESS= San Jose CA 95113 CITY AND ZIP CODE: BRANCH NAME: Limited PETITIONER/PLAINTIFF: Sandra Rivera Medina RESPONDENTIDEFENDANT: Jaime Lujan Rivera ‘ CASE NUMBER: PROOF 0F PERSONAL SERVICE-CIVIL 21CH0°9908 fl r LEVYlNG OFFICER FILE NUMBER‘ ' 21892692 (Do not use this Proofof Service to show service of a Summons and Complaint.) I am over 18 years of age and not a party to this action. I served the following documents (specify): Nr‘ m The documents are listed in the Attachment to Proof of Personal Service-Civll (Documents Served) (form POSrOZO(D)). 3. | personalfy served the following persons at the address, date. and time stated: a. Namei Jaime Luj an Rivera 11 AddreSSI 1315 Michigan Avenue Alviso CA 95002 cA Date: 0311012021 Remarks: Defendant served. d, Time: 6:33 pmD The persons are listed in the Attachment to Proof of Personal Service-Cfvjl (Persons Served) (form POS-020(P)). , Remarks: Defendant served, Hearing date: 04/27/2021 Time: 9:00 am Fee for service was: $40.00 Bil! t0 Court 5. My name, address, telephone number, and, if applicable, county of registration and number are (specify): Namei Deputy Navarro Address 55 WYounger Ave San Jose, CA 95110 Telephone number. (408) 8034300 6. D I declare under penalty of pgrjury underthe laws ofthe State of California that the foregoing is true and correct. 7. m | am a California sheriff or marshal and certify that the foregoing is true and correct. Laurie Smith. Sheriff Date: Thursday. March 11. 2021 County of Santa Clara [AW } Signature of Sheriff‘s Authorized Agent E?mé‘ofiSam?” PROOF 0F PERSONAL SERVICE-CIVIL Wemmgfigflgg P051020 [NewJanuary 1,2005] ’ ' CourtCopy POS-020(D) SHORT TITLE: Sandra Rivera Medina vs. Jaime Lujan Rivera CASE NUMBER _ 21CH009908 ATTACHMENT T0 PROOF OF PERSONAL SERVICE-CIVIL (DOCUMENTS SERVED) (777is Attachment is for use with form POS-020) The documents that were personally sewed are as follows (describe each document specifically): CH-1‘lO TEMPORARY RESTRAINING ORDER, CH-100 REQUEST FOR CIVIL HARASSMENT RESTRAINING ORDERS, CH-109 NOTICE OF COURT HEARING, CH-120 RESPONSE TO REQUEST FOR CIVIL HARASSMENT RESTRAINING ORDERS, CH-120-INFO HOW CAN l RESPOND TO A REQUEST FOR CIVIL HARASSMENT RESTRAINING ORDERS?. CH-800 PROOF OF FIREARMS TURNED IN, SOLD, OR STORED, CM-O1O CIVIL CASE COVER SHEET, CV-5014 DECLARATION IN SUPPORT OF EX PARTE APPLICATION FOR CIVIL RESTRAINING ORDERS, CH-250 PROOF OF SERVICE OF RESPONSE BY MAIL (CIVIL HARASSMENT), CH-800-INFO HOW DO l TURN IN, SELL OR STORE MY FIREARMS?, FW-OO‘I-INFO. FW-OO3 FEE WAIVER Form Appioved for Optional Usemmmmuomfim ATTACHMENT To PROOF 0F PERSONAL SERVICE-CIVIL Page 1 0! 1 P08020