COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. :
Index No.
Clerk stamps date here when form is filed.
CH-131
1 2 3
Proof of Service by Mail
Plaintiff(s)
: : : :
Calendar No.
Name of person asking for protection:
-againstYour name:
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Notice to Server : The server must: Defendant(s) : . . • . . Be. .over .18. years.of. age. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ... . .... . ... • Be a resident or employed in the county where the mailing took place. • Not be a party in the case. THE PEOPLE OF THE STATE OF NEW YORK • Mail a copy of all documents checked in 4 to the person in TO 1 . Complete and sign this form and give it to the person in 2 . PROOF OF SERVICE BY MAIL
Fill in court name and street address: Superior Court of California, County of
Fill in case number: Case Number:
GREETINGS: I am over 18 years of age and am a resident or employed in the county where the mailing took place. I mailed the person in 1 a copy of all documents checked below: WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before a. CH-110, Answer to Request for Orders to Stop Harassment , the Honorable at the Court b. located at County of Other (specify): in room , on the day of , 20 , at o'clock in the noon, and at any recessed or Iadjourned date,of the documents checked above in a sealed this actionand the partthem as described below: to testify and give evidence as a witness in envelope on mailed of the 5 placed copies a. Mailed from (City):_________________________________________ (State): ____________________
4 b. On (Date):________________________________________________ Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to c. To on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained the partythis Address:______________________________________________________________________ as a resultCity: ________________________________________State:_________________ Zip:_____________ of your failure to comply. 6
, one of the Justices of the Name:_______________________________________________________________________________ Court in County, day of , 20
Address:______________________________________________________________________________ City: ______________________________________________State:_______________ Zip:___________
(Attorney must sign above and type name below)
Server's Information Witness, Honorable
Telephone:__________________________
Attorney(s) for 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. Office and P.O. Address
Date:_________________________
(If you are a registered process server):
Type or print server's name
Judicial Council of California, www.courtinfo.ca.gov Rev. January 1, 2005, Optional Form Code of Civil Procedure, §§ 527.6 and 527.9
Telephone No.: Server to sign here Facsimile No.: E-Mail Address: Mobile Proof of Service by MailTel. No.:
(Civil Harassment)
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